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631- 589 -8100
25. -1 -9.7
BOX 9
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1 npetsa t -.that 1 am, wholly and completely responsible for the design and location.Of the proposed system(s); 1) that the a rate saw ii sans stem
above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a ►pu ns o
county Department of Hnitr; and that on completion thWool a ^Certificate of ,Construction Compliance" satisfactory to the Commissioner, of Health will
be "mitted,to tile; Department and a writt n; guarantee W14' i+`.furnished tho.owno►, his successors, heirs, or assigns by the bulkier. that said bulkier will
parse in pod .operating condition any Part. of ,said sewage dlspoaal , system using the period of two (2) years htnnedleMly following thedate Of the iasw
one of the approval of the' Certificate of Conit►uctk►n Compliance' of t lginal .system a an�irtw:ekp; 2) that the drilled well d*W Md above
well ee located, as shown on the approved Pion and that,saW well will ba Instal in accordan w@h ru and ►egu ns of the Putnam
County`DOOarlim m ion[ IIMtth. ",
L ] ; Signed P.E. �R;A.
Addre ) . , icon No
APPROVED FOR CONSTRUCTION: This appr al expires two years from the date i unless cJm'1tru*ctlo4, o the building has Men undertaken and is
revocable for cause or may be amended or modified when considered hoses 1. ommissi r_of- ►leatth. Any change or alteration of construction
IeOuN" a permit. Approved or disposas:of domestic pnNa► awpe water wpply only. c= ���
Rev. C
10/88 Date BY Title
H
Owner or Purchaser of .,icing
Building Constructed by
Location`. Street`
CTS ��rr�2s�rJ
Municipality
Building ,Type.'
Sectiox.,
Block
4
Lot
G7 q _P_ - /? �
Subdivision Name
Subdv. Lot #
GUARANTEE-:OF . SEPARATE SEWAGE SYSTEM .
I. represent that I: am:.wholly and completely responsible . for the
location,.. workmanship ,.material;...construction and drainage of the sewage
dispo.sal..sy. stein:; ±s:ervi'ng,, the.;` above, de.scr.ibed, property, and that it has been
constructed as :shown on: the, approved .plan: or, approved amendment .thereto,
and 'in' accordance' ° °:wi:th Ahe..;.standards. :rules and regulations of the Putnam
County._ Department oi"Health,; and, hereby :'guarant' ee to the owner,'. his
success- hei rs'O,r ;assigns, .to place'. in, good..operating condition any part . of
said. :- syst'ein..,construct:ed by me which ,fails to ;operate for a period of.. two
,years immedzately.following the. date. of initial use of 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 occu-
pant of the.-building utilizing the .system.
The unders.igned.further. agrees to accept as conclusive the determin-
ation of:tYe Director of.the.`Division of Environmental Health Services
of the Putnam; "Count y.Department of Health as to whether or not the fail-
ure of-the, - sY:s't.'em ..t 9 operate was caused by the willful egligent act
--of the.occupant of the building utilizing the system ---
Date t is.d of �) Ui� e. 19 / Signature
(
Title
S �NPciUI29__
eG�I eI'N7- r4, iUWN ep.
PIN,
Corporation Name if cov p.)
Address
THREE (3) COPIES.ARE REQUIRED. WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Healta
Owner or Purchaser of' ..ilding
4/1
Building Constructed by
J'/W7)e 4 A�F
Location`. ..Street`
CTS
Municipality
r�g s 1i�J',T% 4 L
Building Type.
Sectio;.,
Block
Lot
G -Dre
Subdivision Name
Subdv. Lot #
GUARANTEE.OF. SEPARATE SEWAGE SYSTEM
I. represent that,I:ain:.wh.olly and .completely responsible for the
...
location 1- workmanship, :mat6rial ._,cor struation and drainage of the sewage
disposal system.:,serving: the..- :.above de:scr.ibed' property, and that it has been
constructed, '.as �';shown-;.on: ;the,. `approved..plan.. or.; approved amendment .thereto,
and in' accordance'` with ;;the.,atandards;: ::rules and regulations `of the Putnam
County;�Depar,tment: of and, hereby ,`guarantee .to, the owner ,:.-.his .success-
ors-, heirs--:or- :assigns, `ao plaae..in, good. operating condition any part . of
said.: sySVbM :,constructed .by one rhich .fails to :operate for a period � of. two
years immediately following�:ahe. date of initial use of the sewage disposal
system; .or any'-repa.irs made by..-.me to such system, except where. the failure
to operate properly is... caused by. the willful or negligent act of.the occur
pant of the:building utilizing the system.
The undersigned. further agrees to accept as conclusive the determin-
ation of :t1e ::Director of the*'. "Division of Environmental Health Services
of the Putnam.:Courity Department of Health as to whether or not the fail-
ure of -:the 'sy'stem. to, operate was - caused by the willful egligent act
...of -the- -o•ccupant=--of the--- building-.utilkzing the.-system
Date ,, t is C�d of; _1 C-4 g
n e 19 / 2 Signature _
Tit1e
6- NA-rvi2r-- n
1LLl�/Y1 g`�K 4A)
-EN • GGNT �jGc)N �j2 -
VIA, :
Corporation Name if corp
Address
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF. COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Healt!
Owner or Purchaser of' . -ildzng Section.
. Uf l i/1
�iQOT 71 �y2- .3LDG .
Building
Constructed by
Location'.-
C7�
Street",
Municipality
1�j5� S1 % )'JT% A L
Building
Type.
Block
Lot
Subdivision Name
Subdv. Lot #
GUARANTEE;OF SEPARATE SEWAGE SYSTEM
I. represent that Iam.wholly and completely responsible for the
location,.. workmanship, materi,a�.;..,construction and drainage of the sewage
disposal. system serving the above de.scr.ibed' property, and that it has been
constructed.`.as '.shown`:.on.: ahe. _appr..oved. plan.. or. approved amendment . thereto,
and : in' acc..ordance`::with .:;the. standards y :rules and regulations 'of the Putnam
County. Depar,tment.: of Health :. ai d, _hereby. :.guarant.ee to. the owner,': his success-
ors', heirs'or. assigns, ao plac:e' in, good operating condition any part of
said::system.,constructed . by' mewhich fails to ;operate for a period of. two
:years immediately following.:the date of initial use of the sewage. disposal
system; .or any r.epa.irs made by. me to such system, except where the failure
to operate properly is- _caused,by.the willful or negligent act of the occu-
pant of-the .building utilizing the system.
The undersigned.,further agrees to accept as conclusive the determin-
ation of ..the .'Director of.the`Division of Environmental Health Services
of the Putnam;:County Department of Health as to whether or not the fail-
ure of- the- .syst.e.m :to operate was caused by the willful pr--Ir egligent act
of -thee occupant of the building utilizing the s-Wt em
Date t isd of _1 �i� e 19 Signature, „ /
,`✓,
Title /1 e�/ r� Cam° l /�%4� f /o --7
�S; I6NAIvf 2r
T C-P-
VAI
T
Corporation Name if co p.)
Address i L S7 3
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO'FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Healt;
APPENDIX C FINAL SITE INSPECTION DATE: /9 h 7
Inspected by:
- STREET LOCATION - - /1 OWNER i
PERMIT # TM # OR SUBDIVISION LOT #
I. SEWAGE DISPOSAL AREA
a. SDS area located as per approved
b. Fill section - date of placement
C.
Natural oil not sti
d.
Stone rush etc. r�
e.
100 ft. water
II SEWAGE DISPOSAL SYSTEM
a.
Septic tank size -
b.
Septic tank install
c.
10' minimum from fo
d.
DISTRIBUTION BOX
Roam allowed for expansion. 100%
1. All outlets at s
/1 O .,, y 2 . Protected below
',30'
3. Minimum 2 ft. or
YES NO COMMENTS
W I DTH AVG. DPTH .414.2 e 4:- r' ivy
from SDS area
Js
1,250
- wter 71 ested� ^�
etween box'and trenches
e. jum 1 ON box - proper ! y set
f. TRENCHES
1.'Length
required - Liz Lei
2.
Distance to watercourse measured
3.
Installed according to plan '
4.
_Slope of trench acceptable 1/16 - 1/:
5.
10 feet from property line - 20 feet
6.
Depth of trench < 30 inches from sur-
7.
Roam allowed for expansion. 100%
B.
Size of gravel 3/4 - 1;" diameter cli
9.
Depth ,of gravel-in trench-12" minimu
m
-10 : Pipe ends capped - -
g. PUMP OR DOSE SYSTEMS
1. Size ,of pum chamber
2. Overflow tank
3. Alarm. visual /audio
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
III.. HOUSE
a.
House located pei
b.
Number of bedroa
IV. WELL
Well located as i
.
Distance from M
c.
Casing 18" above
d.
Surface drainage
V. OVERALL WORMANSHIP
a.
Boxes properly g
b.
All pipes partia
c.
All pipes flush ,
d.
Backfill materia
e.
Curtain drain in
f.
Curtain drain ou
g.
Footing drains d
h.
Surface water pr
i.
i
Erosion control
R
0
i
E• `sue.- la
s7
4e s-1
Oreilw
pee-7` sz.d
Iva
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
,p4
Town Village City
, .r �
Tax Grid Number
WELL OWNER
jjg
N
Mailing Address
O'Priv to
O Public
USE OF WELL
0)- primary
2- secondary
19 RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY (J AIR /COND /HEAT PUMP 0 ABANDONED
0 FARM 0 TEST /OBSERVATION 0 OTHER (specify
M INSTITUTIONAL 0 STAND -BY O
AMOUNT OF USE
YIELD SOUGHT /J_� gpm /# PEOPLE SERVED /EST:
13 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION
'Q NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL
OF DAILY USAGE Sd Sal
CIADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
`
WELL TYPE
®DRILLED
DRIVEN EIDUG
GRAVEL.
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES L/ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION
Lot
WATER WELL CONTRACTOR: Name ""(�j. Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1� NO
NAME OF PUBLIC WATER SUPPLY: 1 -/ TOWN /VIL /CITY
DISTANCE- TO PROPERTY -FROM NEAREST WATER MAIN: _...
LOCATION SKETCH S SOURCES OF CONTAMINATION PROVIDED
®ON SEPARATE SHEET
(date) ignature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt -y (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 such a manner as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: -3 19
Date of Expiration 19_ Permit Issuing Official
Permit is Non_ Transferrable White copy: HD File Pink copy: Owner
3/89 1 Yellow copy: Bldg. Insp. Orange copy: Well Drille
t
48`
L+C -aCJ 1. � •..� � - �.
((11 BEDROOM .c , �.. �
y'•8' x 12' 4' _
BEDROOM 3 . —
..WALK' IN
t8• -0 "x 10• -0" CLOSET
o .. '
Moo
r--� �Tf •; •:
r PGTi:fM C�T1 `'.T'`i� L'% �;� �,�,•: ,,.'r �,� �,.Aj',ry+�
MA-STSA B�DRTJO�:1'
_ ?El�'N r t•r .,. -
2 O
17'-0 x 16'•8'
BEDROOM —J J -
l STVO -�
S 0 N D :.F
48
Lit 4t.—U.
.• KITCHEN '� � �K•.�`�
PINING ROOM p �� MORNING F OOM 13' 0'• x 12'.0-
• J ��
LIVING MOON
13•.O••x 1l••0•'
�RST FLOOR
Cyr- : - -4 -'..16
t
.4.fOASOVE
: IEN
•i J
u
fOYEm
FALAII V ArinU
4828
• 1
gqm
::. APPENDIX 3
PUT.NAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
REVI W SHEET,_ ffor�CONSTRUCTION PERMIT
STREET LOCATION d/' / ��'\ fE OF OWNER
BY B. HEDGE R.NfORRIS OT ER DAT
DOCUMENTS.,
Y "
Y N,
! PE - APPLICATION E. A ; SHOWN; GRAVITY FLOW, SUFF.SIZE
I IF .P D BOX SHO DETAILED
ti PERMIT Eil PWS LET i ER p(S -NO. OF BEDRGO1iS
' E RS AUTHORIZATION SSDS•S W /I` 200 FT. OF PROPOSED SYSTEM;"
_ SI . °DATA SHEET(DDS) -
'
R CO RATE RESOLLTIOiN i _.
HO • SETBACK NECESSARY (TIGHT' LOT)
L--! �NS THREE SETS i
{OU SEWER - 1,14"/FT. 4"0: TYPE PIPE
i ROUSE PL-kNS - TWO SETS - BENDS :.LXX. BENDS -15 W /CLEA1'WL7
VARIA.NCE REQUEST F
FILL SYSTEMS
DIVISION ^�
RRIEER
LE _ SUBDIVISION
TaL SLOPE 3:I TO GRADE
S�$ �ISION APPROVAL C'riECXED FILL NOTES
ERC ATE RTIFICATIO\ \OTE
Q"[-IRED DE.PT -r a DEPTH�G:LGES
`ti`,CCRTAIN Dk�'f REQUIRED IRED -- .�ST.�NDPIPESt $
.. _ �RFII.L" PROFILE & DIME_ NSIONS -
A VOLLME "� 6
ERAL �F "FIL`I\ E\PA\SIO� \' ARE ��v`.�t
,4 a . �
y �O DDS PL ��\fi 3c PEzLtiIII 5r1� E �� ^� . "F ��'. LFTRE \CH PROVIDED C�60 FT 1I.4:C
��^ a :s•� �? ': - :, F? rh i -t ,i;' •X.. y..t+?'°'a'�,:. .� w. ' -fi t ,�• f . t4 1� t
az r Y wa
s 969 itiEIGHBOR tiOTI i. iCATION ,r f PARALLEL TO CONTOURS
E�'a \SION PROVIDED '` {
FLOOD ELEV. TI,,�
SEPARATION DISTANCES SPECIFIED ON PLAN
y
r R UIRED DETAILS aV PLANS :y r <'FIELDS
`. ..� .;YiC - r .
' E SYSTEM ( \CRTH ARROW) ' F, 10 TO P L DRIVEWAY, LARGE TREES TOP:OF FILL
' i I 10�TQ F, \RATION WALLS m 1�'.1,VELL TOP L
YDRAC,LIC PROFILE GRAVITY FLO�1
��R�CTION NOTES (GRINDER NOTE) k ` k IOO�TO ELL; 200' IN D L.O D , 150 PITS r •F: `
i
DES DATA PERC AND DEEP .RESULTS � 100 TO STREANI WATERCOURSE LAKE (I \C.EXPA�y)
rmOOTrCOtVTO.[ RS EXIST: \G &PROPOSED °50 TO CATCH BASIN 3T STOR�IDRAIN, P[PED N�►TER
rst' �,..5- '{.{`9r r,`.,s.P,. �, rr,3 ab3"4'-3;1 r'• .�c; h. [,;s 4r� :•:Y:F':i Cnwi S'e7o'e 2;�C,ai`•,itr - ^:s~ se y t=
EVAY � SLOPES QUT _ y IO TO ,� ATER LINE (PI
!'G.. iks;F)ir ;t rya iw t: F•; F ?. ST�i? q v.
y ��w , � 0 I \TEI, —N ENT DRAIN`AGE�COURSE
, D07L ,GUTTER/QLRTAI\ I;R?�INS z 4 .w� � i ... r, ..._ . � , .k � �4;''z,,- 7'v �.�,. 3� ,
Y • S)Y .. �§ •t
441E IOi� CONTROL RO(ISE.tiELL SSDS' hz a Q'OO FT RESERVOIR; ETG:: y tSOtFT GAbLEYSYS,TEliS`a�',
s ie °.a2a �a.'.,x..r.: -•, •,•s. .� s•: 5' cz, r 1 p:; ,.`.'aFi t.F,: �A it - rie..�+.� ri'"C.?.ss{ti' t`dV£c +<F tit„_.. _2 a,z x ,x�t x�ts':i
t 5 ROS,I<JN NTROL \07E 5`�fl�' $C1D- S'?S_°o .one �$� �00�30� �oQ�35 +c7aollppw <loy.,
.q °s„^� ? >_ .'Ft::'i..w,• e- )r.3..::. ;:1: .a airy Yt -::,., iaiw."• rMUM' ' sN sue:
` . PER ' Y D,EEP;I iOL ES LO ` TO,Q D DISHA�VITEir 1 S' CONS,D{�1YrDISM,
c n. w C ig, gta r`�' h � k
n' "e�- ws"'SNHeF'k•.r .RT�...rr..r .r % •.i'.� .r ::u ci `..1: "-"r� ai• dtM1Y- �SaEP.TIGTANK��'T"'z''F�'v 5,'`i5y`'r"�Kt'�?ir:¢ 1 d 4� F'.. taS, Y•..' -•y ily +i
RESE`T�TIbEOF.PRI�IAR2 A \'D f � �� Fq
;. i" y ,; _ . EXPA \'SIGN h„ r ��r�> : �;f,\* : s L
1`ti
FO�C�hDATIO�\ 5(?
,x3 `x ,,�;ffy'a,rT �..#. t _ ti : s +i_ r• . s- -� '� ?zc:�.ty'g" F .q}s +1`,y,'.�-.'.xz' -'n,. *'r'? ti '" �2 „Ff �M''.4 5a5?. 7''"'i3cE •i�F; >r' ,uh ?4 M ' p w�'aA -.. Sr.As -�aC` ,.,ya, : ^,h
�YL rra+ijW 3'aY �. d>,, t"'"^'?.ue.£t�i a{! �` ,1s"'"`,e to $3 ¢, „fit !::' +�'it •rP�
y � ��r��' � .., �. . �. f t ». -. � L ?'-wv �; �2 ,s sT 1 x rz L,_a ,�,� t �� i." ,, {. �+'`�si•:•
. � tip° ����/ ,�y.,.r (ed:.3x i/ F• •tI it �.f'
--
LAURENT ENGINEERING
ASSOCIATES, P.C.
- MILLBROOKE OFFICE CENTRE
Route 22 8 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
April 19, 1995
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Proposed SSDS
Car -Dee Bldg. Corp. Subdivision - Lot #7
Partridge Lane
Town of Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing SS -7. "Proposed SSDS ", dated
4- 18 -95.
2. "Application For Approval of Plans for a Wastewater Disposal
System ".
3. "Construction Permit for Sewage Disposal System ", dated
4- 18 -95.
4. "Application to Construct a Water Well ", dated 4- 18 -95.
5. "Design Data Sheet ".
6. "Letter of Authorization ", dated 7- 20 -94.
7. "Corporate Affidavit ", dated 7- 18 -94.
8. Cut sheet for Goulds submersible pump Model 3871.
9. Two (2) copies of Residence Floor Plan(s), for "Bedroom
Count Only ".
10. A check in the amount of $300.00, for Review Fee.
April 19, 1995
Page 2
94051 - - -- -
Kindly review the nclosed items and contact us with your comments
and /or approval at your earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
�t
Harry W. Ni hols, Jr., P. .
HWN:bd
94051 -7
enc.
cc: Mr. G. Macaluso w /enc.
0. Name of Lead Agency rJ /�
11. Is this project in an area under the control. of -local planning, zoning,
-or other- officials; ordinances? ::.:-::-:::. ..-.::':.:::.'.:.'.:':::':'.:'. :: ..._ ...... hl.�l......_....... _ -..
�2. If so, have-plans been..subrnitted t•o such. author A ties? ....__......,......... WA
13. Has preliminary approval been 'granted by such authorities? 0A Date Granted:
14. Type of Sewage Disposa-1; System Discharge...... • Surface .Water v Ground Waters
15. If surface water discharge, what is the stream class designation ?........
o. Waters index number. (surface) ............................................ N► /A
7,
Is project located near a public water supply system ?. .................. N0
3.' If yes, name of water supply Distance to=water supply ,
4. Is project site near a public sewage collection or disposal system ?..... X10
0. Name of sewage system KMA- Distance to sewage system
I- Date observed: 23. Name of Health Inspector: OS . Q . �J, -7UP
:. Project design flow (gallons per day) ..................................... 800
O )'
APPLICATION FOR APPROVAL OF PLANS- FOR 'A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant:
2. Name of Project:
3.._• Location /C:
4. Project Engineer: KD, I'L Y W IJI
rH0j,4_, S. Address: Ni,1t� ma,Dr:g Ome-o
License Numbe'r: 60.1
Phone: <'L1 �2
6. T e of Pro ect
Private /Residential•
Food .Service :' • ....Comiercial
Apartments
Institutional Mobile Home Park
.Office Building
Realty Subdivision Other (specify)
: :3
7. Is this project subject* to State
Environmental Quality Review (SEQR)?
Type Status (Check One) Type I..
Exempt ✓
Type II.
Unlisted
8. Is a Draft Environmental Impact Statement
(DEIS) required? ............. IJU
g. Has DEIS been completed and found
acceptable'by Lead•Agency? ....:.:..:. tJ
0. Name of Lead Agency rJ /�
11. Is this project in an area under the control. of -local planning, zoning,
-or other- officials; ordinances? ::.:-::-:::. ..-.::':.:::.'.:.'.:':::':'.:'. :: ..._ ...... hl.�l......_....... _ -..
�2. If so, have-plans been..subrnitted t•o such. author A ties? ....__......,......... WA
13. Has preliminary approval been 'granted by such authorities? 0A Date Granted:
14. Type of Sewage Disposa-1; System Discharge...... • Surface .Water v Ground Waters
15. If surface water discharge, what is the stream class designation ?........
o. Waters index number. (surface) ............................................ N► /A
7,
Is project located near a public water supply system ?. .................. N0
3.' If yes, name of water supply Distance to=water supply ,
4. Is project site near a public sewage collection or disposal system ?..... X10
0. Name of sewage system KMA- Distance to sewage system
I- Date observed: 23. Name of Health Inspector: OS . Q . �J, -7UP
:. Project design flow (gallons per day) ..................................... 800
2.
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. Qo
26. Has SPDES Application been submitted to local DEC Office? K) /A
27. Is any portion of this project located within a designated Town or State
wetland ? .................... ............. ............................... r)
28. Wetland ID Number ......................... ............................... Oils-
29. 'Is Wetland Permit• required? .............. ...............................
Has application, been made to Town or Local DEC Office? ................ 11)Al.
30. Does project require a,DEC Stream Disturbance Permit? ................... •
31. Is or was 'project site used for agricultural activity involving application
of pesticide$ to orchards or other crops, solid or hazardous waste disposal;''-
landfilling,*sludge application or industrial activity? :....... YES or N0* ' t\) 0,
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. ource or contamination? ............... or NO X)1
DESCRIBE:
33. Is there a local master plan or file -with the Town or Village ?. ........
34. Are community water, sewer facilities planned to be developed within 15 years? U1JKNe710t�
35. Are any sewage disposal areas in excess of' 15ro slope? ..._ ^.•..................... 00
36. Tax Hap ID dumber
37. Approved Plans are' tobe. returned to: Applicant Y" Engineer
If the application is signed by a person other than the. applicant shown in Item .1, the.
°pplication must be-accompanied by y-a Letter of Authorization: Failure to comply with this
provision may be grounds for the rejection of any sub,•nission.
I hereby affirm, under penalty of perjury,- that information provided on this
form is true to the best of cy knowledge and be 1 ief. Fa Ise statemtents made
herein are pun ishab ]e as a Class A Hisderreanor pursuant to Section 210.45 of
the Pena 1 Lax. // n
>IGNATURES & OFFICIAL TITLES:
of
G-
M
-AILING ADDRESS:. iJ ,Y. �050GI
'UI-NAM CaJNW • E• • • f� •
aF-A-
DIVISION OF /• •' M Y• HEALTH SERWCES
DESIGN nllA SHEET- SUBSUFACE SERAGE DISPOSAL SYSTEM FILE NO.
Owner Address i f O E
x,ocated at (Street) l�G'(2 d IC-t (f� Sec. j . Block_ Lot
Undicat'e nearest cross street)
It icipality pfn`Tenx�N Watershed 6%0OTQ/V
SOIL PERCOLMON TEST DATA REQMED TO BE SUB�aTTED WITH APPLICATIONS
Date of Pre- Soaking I ..Date of Percolation Test
HOLE
NUEBER CLOCK TIME
4
PERCOLATION
PEROOLATIUN '
Run Elapse
Depth to
Water Frcm
Water,%eve?
;
_
No. T i
Ground
Surface
In Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop In
Min /In Drop
•
Inches
Inches
Inches
Z11
-z-
2. I = I : 3 s 30
3 X60
4 ._
..5 _
': ✓8 23 I Z 15 3
C3
4
S
1
2
4
S
rev. 9/85
1. Tests to be repeated at satre depth until approximately equal soil rates
are obtained at each percolation, test. hole. All data to' be m*nitto -d
for review.
2. Depth lreasurements to be made from top of hole.
DESCRT"TION OF SOILS EMDOUNTMFD IN TEST' HOLES
DEPTH HOLE NO. :HOLE M. HOLE NO.
G.L.
1`
2`
4'
5`
6'
7, .
8'
10`
11'
12'
13`
14` - -
INDICATE LEVEL AT WHICH GROUND ATER IS ENCOUNTERED
_..' ......:__...- INDICATE LEVEL TO WHICH- MTER LEVEL RISES AFTER -BEING ENCO 7,(
DEEP HOLE OBSERVATIONS MADE BY: �C ffD u (��� DATE: 5 /Z
DESIGN
Soil Rate Used Min /1" Drop: S.D. Usable Area Provided
No. of Bedrooms < Septic Tank Capacity / 250 gals. Type CON6-
Absorption Area Provided By Jrj00 L.F. x 24" width trench
Other
Nam -JA) Kl I CHa,� Signature
Address f DI G���`t SEAL
e' ' f✓I r> t r w
• 2•s
. !. .� ur F l !tea �:4y ra�j� �
THIS SPACE MR USE BY BEALTH DEPAREEM ONLY:
Soil Rate Approved sq. f t,%g - -Checked by Date
,.v r "' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROMIENTAL HEALTH SERVICES
Date—
Re: Pj:-operty 0'
Located at
T,
(T) Section 'Block i Lot
Subdivision of
Subdv. Lot Filed Map # Date
Gentlemen:
This letter is to authorize /4-1 A,6- f
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
a. 6cessax�Y papers on'my behalf.-in•
Dep ' r'tm*eftt of Health, and to sign a n
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of ArticI6 145 or
147, Education Law, the-Public Health Law, and the Putnam County Sani-
tary Code.
Countersigne
P.E., R.A., #1
Address
IZ rD
279_
Tel-epho'ne
Very truly you
Signed -
Ourn6-of' Property
Address
Town
Telephone
Putnam County Department of Health
Division of Environmental. Sanitation
AFFIDAVIT - CORPORATE WNER APPLICATION
FOR PERMIT. APPLICATION SUBMITTED-TO
PUTNAM COUNTY HEALTH DEPARTMENT
T0: Co 'ssio er of cal %th - In the matter of application for
G% pct ^ �' � �C-� %� � • • � r
_ .. _ .._...... represent.
that.I am an offi er or employee of the corporation and am, authorized'
to act for. /A Q
(namee of corporation
•
having offices at
Whose officers -are
President -a
(Name and Address)
Vice-President
(name and Address)
Secretary _
-' -' (Name and Address) -' —' —
Treasurer' _ _
(name and_ AT
r
and that I= am-and wx'11 be individually responsible fon any'or all apt¢
of the- corporation with respect to the approval requieste rid•all .sub � .
sequeit acts relating -thereto.
Sworn= to before me this A day . Signed
of 199 Title
o ary 13ibli
F EG. MOOG
QUALIFIM IN DUT CHESS b "'JN `1
fl'1' COKWIMCIOR Mpir c,l Ric, 4
Corporc to Seal
I
�O -,- :� -7
` manual op
'models in(
Switch as<
tomatic and.
;fi'.` Automatic
-
Mercury Float
bd and 0'rqset�,,--',y
Goulds
Submersible
Effluent
Pumps
,@--I
L
3871
FEATURES~
SPECIFICATIONS
. .. ..
'
Pump: ,Impeller Jhermop
Vortex • Solids handling .
pump
capability:
out vanes ,
M mechanical ""
protection
-To
D_i
M
a�; I i., N.:
;E(
j1h1
ty . qi,
��I
98
Submersible
,.Effluent Pump._....
METERS FFFT
8
7
_ o
a
w 6
U
5
a
z
0
4
H
O 3
H
2
1
0
MODEL: 3871
SIZE: 3/4" SOLIDS
RPM: 1550
HP: 0.4.
0 10 . 20 3U 4 ou urrw
0 2 -4 6 8 10 12 m3 /h
CAPACITY
Cry G OU LDS PUMPS, INC.
SI. razes II raM (31ae
Effective October, 1988
01988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A.
New York State Department of Environmental Conservation
' 21 South Putt Corners Road, New Paltz, NY 12561 -1696
(914) 256 -3000 - Division of Regulatory Affairs
FAX (914) 255 -3042
April 28, 1995
ATTN GREGORY MACALUSO PRESIDENT
MACAL DEVELOPMENT CORP
175 E HOLMES RD
HOLMES NY 12531
Re: Freshwater Wetlands Permit
Permit No.: 3- 3724 - 00100 /1 -0
Town of: Patterson, Putnam County
Facility Name: Car -Dee Building Corporation Subdivision
FW /SD Resource No.: BR -3
Dear Mr. Macaluso:
PERMIT MODIFICATION
Q��N DqY
,GP 1f
e 2
fO��ENiA% tt
Michael D. Zagata
Commissioner
In accordance with your consultant's written request of April 20, 1995, the above permit is hereby
modified as follows:
1. To change the permittee to Macal Development Corporation, and
2. To extend the expiration date to December 31, 1996.
All other terms and conditions remain as written in the original permit. Please attach this
modification to the front of this permit (copy enclosed).
MDM /LGB /btmacaluso. hr(mm l)
Enclosure
cc: Law Enforcement (2)
R. Wood
S. Smith
ITTi Nichols-, - _Laurent,. Engineering
Sincerely,
Michael D. Merriman
Deputy Regional Permit Administrator
Region 3
95 -20.6 (9186)-25c
DEC PERMIT NUMBER
1- 3724- 56 -1 -0
FACILITY /PROGRAM NUMBER(s)
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
AM
v
PERMIT
Under the Environmental Conservation Law
a6NYCRR 608:
Water Quality Certification
DArticle: 17, Titles 7, 8:
SPDES
aArticle .19:
Air Pollution Control'
Article 23, Title 27:
Mined Land Reclamation
Article 24:
FN Freshwater Wetlands
N -New,. R- Renewal, M— Modifications,
C— Construct ('only), O— Operate ('only)
EFFECTIVE DATE
EXPIRATION DATE(s)
December 31, 1990
Article 15, Title 3; 6NYCRR 327,
Article 25:
328, 329: Aquatic Pesticides
ADDRESS OF PERMITTEE
Article 15, Title 5:
9 Quincy Lane White Plains, NY 10605
Protection. of Water .
Article 27, Title 7; 6NYCRR 360:
Article 15, Title 15:
TELEPHONE NUMBER
Water - Supply
aArticle
15, Title 15:
27, Title 9; 6NYCRR 373:
Water Transport
aArticle
15, Title 15:
LOCATION OF PROJECT/FACILITY
Long Island Wells
Article 34:
15, Title 27:
aArticle
Wild, Scenic and Recreational
Putnam
Rivers ..
AM
v
PERMIT
Under the Environmental Conservation Law
a6NYCRR 608:
Water Quality Certification
DArticle: 17, Titles 7, 8:
SPDES
aArticle .19:
Air Pollution Control'
Article 23, Title 27:
Mined Land Reclamation
Article 24:
FN Freshwater Wetlands
N -New,. R- Renewal, M— Modifications,
C— Construct ('only), O— Operate ('only)
EFFECTIVE DATE
EXPIRATION DATE(s)
December 31, 1990
PERMIT ISSUED TO
Article 25:
ADDRESS OF PERMITTEE
Tidal.Wetlands
9 Quincy Lane White Plains, NY 10605
Article 27, Title 7; 6NYCRR 360:
TELEPHONE NUMBER
Solid Waste Management'
_
aArticle
27, Title 9; 6NYCRR 373:
Proposed subdivision west side of Haviland Road south of Brimstone
Hazardous Waste Management
LOCATION OF PROJECT/FACILITY
COUNTY
Article 34:
UTM COORDINATES
Coastal Erosion Management
Putnam
Article 36:
Floodplain Management
DESCRIPTION OF AUTHORIZED ACTIVITY
F7Articles
1, 3, 17, 19, 27, 37;
of the above wetland
in order to construct drilling rig access roads and drill three wells; construct a
6NYCRR 380: Radiation Control
PERMIT ISSUED TO
Car -Dee Building Corporation Attn: Pat Carbone
ADDRESS OF PERMITTEE
9 Quincy Lane White Plains, NY 10605
AGENT FOR PERMITTEE /CONTACT PERSON
TELEPHONE NUMBER
Laurent Engineering.Associates
( 278 -6108
NAME AND ADDRESS OF PROJECT /FACILITY (If different from Permittee)
Proposed subdivision west side of Haviland Road south of Brimstone
Road:
LOCATION OF PROJECT/FACILITY
COUNTY
TOWN1MT4]t )UXN. �£
UTM COORDINATES
Freshwater'tdetland BR -3'
Putnam
Patterson
DESCRIPTION OF AUTHORIZED ACTIVITY
Place approximately 330 cubic yards of fill within the 100' buffer
of the above wetland
in order to construct drilling rig access roads and drill three wells; construct a
stormwater. drainage outlet structure in,the buffer in accordance with a preliminary sub -
:•division�plan dated March 31, 1988 prepared by Laurent Engineering
(last revised
riarcii23 1989 and as conditioned herein. •
GENERAL CONDITIONS
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli-
.....
ance with the ECL, all applicable regulations and the conditions specified herein or attached hereto.
1 . The permittee shall file in the office of the appropriate regional permit administrator, or other office designated in the special conditions• a notice of intention to commence
work at least 48 hours in advance of the time of commencement and shall also notify him /her promptly in writing of the completion of the work.
2. -The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if
the public interest so requires pursuant to ECL §71 -0301 and SAPA §401(3).
3. The permittee has accepted expressly, by the execution of the application, the full legal responsibility foc all damages, director indirect of whatever nature, and by whomever
suffered, arising out of the project described herein and has agreed to indemnify and-save harmless the State from suits• actions, damages and costs of every name and descrip-
tion resulting from the said project
4. The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and• if requested• hold a hearing when:
a) the scope of the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or
b) the permit was obtained by misrepresentation or failure to disclose relevent facts; or :
c) newly discovered information or significant physical changes are discovered since the permit was issued.
5. The permittee is responsible for keeping the permit active by submitting a renewal application, including any forms, fees or supplemental information which may be required
by the Department.rno later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date.
6. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of. others in order to perform the
permitted work or as authorizing the impairment of any rights• title or interest in rreeaLofp�,sonal property held or vested in a person not a party to the permit.
7. The permittee is responsible for obtaining any other permits• approvals, lands, e. ements and rights-of -way which may be required for this project.
8. Issuance of this permit by the Department does not, unless expressly provided or, modify, supersede or rescind an order on consent or determination by the'Commissioner
issued heretofore by the Department or any of the terms, conditions, or r quirements contained in such order or determination.
9. Any modification of this permit granted by the Department must be in riting and attached hereto.
PERMIT ISSUANCE DATE PERMIT ADMINISTRATOR , De ty ADDRESS 1 South Putt Corners Road
/9a9 William St le New Paltz,' NY 12561- 6.
AUTHORIZED SIGNATURE J, / i _ ,1_,
Page 1 of 4
I —16-6a (1186) -25c Freshwater Wetlands
—
That GENERAL CONDITIONS FOR AR..�LES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part b.,.. ( )
That if future operations by the State of New York require an al-
teration in the position of the structure or work herein authorized, or
if, in the opinion of the Department of Environmental Conservation
it shall cause unreasonable obstruction to the free navigation of said
waters or flood flows or endanger the health, safety or welfare of
the people of the State, or cause loss or destruction of the natural
resources, of the State, the owner may be ordered by the Department to
remove or alter the structural work, obstructions, or hazards caused
thereby without expense'to the State, and if, upon the expiration or
revocation of this permit, the structure, fill, excavation, or.other
modification of the watercourse hereby authorized shall not be com-
pleted, the owners, shall, without expense to the State, and to such
extent and in such time and manner as the Department of Environmental
Conservation may require, remove all or any portion of the uncompleted
structure or fill and restore to its' former condition the navigable
and flood capacity of the watercourse. No claim shall be made against
the State of New York on account of any such removal or alteration.
That the State of New York shall in no case be liable for any damage
to the structure or t, o. k he ein ..z be caused
by or result from future operations undertaken by the State for the
conservation or improvement of navigation, or foi other purposes, and
no claim or right to compensation shall accrue from any such damage.
Granting of this permit does not relieve the applicant of the responsi-
bility of obtaining any other permission, consent or approval from
the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State
Office of General Services or local government which may be required.
All necessary precautions shall be taken to preclude contamination
of any wetland or waterway by suspended solids, sediments, fuels,
solvents, lubricants, epoxy coatings, paints, concrete, leachate or any
other environmentally deleterious materials associated with ti'�-
project.
14. Any material dredged in the prosecution of the work herein permitted
shall be removed evenly, without leaving large refuse piles, ridges across
the bed of a waterway or floodplain or deep holes that may have a
tendency to cause damage to navigable channels or to the banks of
a waterway.
15. There shall be no unreasonable interference with navigation by the work
herein authorized.
16. If upon the expiration or revocation of this permit, the project hereby
authorized has not been completed, the applicant shall, without expense
to the State, and to such extent and in such time and manner as the
Department of Environmental Conservation may require, remove all or
any portion of the uncompleted structure or fill and restore the site
to its former condition. No claim shall be made against the State of
New York on account of any such removal or alteration.
17. If granted under Article 36, this permit does not signify in any way
that the project will be free from flooding.
18. If granted under 6 NYCRR Part 608, the NYS Department of Environ-
mental Conservation hereby certifies that the subject project will not
contravene effluent limitations or other limitations or standards under
Sections 301, 302. 303. 306 and 307 of the Clean Water Act of 197.7
(PL 95 -217) provided that all of the conditions listed herein are met.
19. All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or his agent as paPt
of the permit application.
Such approved plans were prepared by
- on
- "x
In
i
95.20 -6( (1:87) —:Sc
NEw.Y
STATE DEPARTMENT OF ENVIRONMENTAL CONSERV,
SPECIAL CONDITIONS
AO
24 Freshwater Wetlands '
For Article ( ..Freshwater - )
1 -. -- -To sat•is-fy -the - requirement of General Condition .No-.--l-,- the permittee or a
representative shall .contact, by telephone, the..Division of Law Enforcement
in New Paltz (914/255 -5453) 48 hours prior to the commencement of any por-
tion of the project authorized herein.
2. The permittee shall require that any contractor, project engineer, or other
person responsible. for the overall — supervision of; this project reads,
understands and complies, with this permit, including all special conditions
to prevent environmental degradation.
3. Prior to commencement pf any of the wetland buffer disturbance activities
authorized herein a row of staked hay bales; silt fence,' or -other erosion
control measures shall be installed at. >the perimeter of the areas to be
(isturbed. This barri er to sediments (including well drilling slurr� is;
to be maintained until all disturbed land is heavily vegetated. ,
4.. As-depicted on the approved plan and in accordance-with detail sheets dated
June 15, 1988 submitted with the permit application, the stormwater drainage
outfali structure shall terminate wi:th.a runoff dissipator trench immed-
iately preceeded by a temporary sedimentation basin. As indicated,the
latter shall be fully maiptained,until all exposed are fully stabilized.
5. All areas of soil .disturbance resulting from this project shall be seeded
with an appropriate - perennial grass seed and mulched with hay or. - straw
within one week of final grading. Mulch shall be maintained until a'
suitable vegetative cover is estab.lished.
6. No disturbance to the wetland proper is authorized.
7. For any of the lots in the subdivision containing portions of Freshwater
Wetland BR -3 or the adjacent 100 foot control area, the deed for each
such property shall contain a restriction as written be
"For as long as any portion of, the'property described'in this deed'`is
_subject to regulation under Article 24 (the Freshwater Wetlands Act) of the
Environmental Conservation Law of the State of New York (ECL), there shall
be no construction, grading, filling; excavating, clearing or other regu-
lated activity as defined by Article 24 of the Environmental Conservation
Law on this property within the wetland area or 100 foot control areas as
shown on the Final Subdivision Plat at any time without having first secured
the necessary permission and permit required pursuant to the above noted
Article 24. This restriction shall bind the Grantee's, their successors and
assigns and shall be expressly set forth in all subsequent deed to this
property ".
If requested by the Department, the'permittee shall submit a copy of the
deed of the first sale for an affected lot to the Regional Permit
Administrator 'in the New Paltz office 'within 30 days of receipt of the
request.
DEC PERMIT NUMBER Continued on next page.. .
3- 3724- 56 -1 -0
FACILITY 10 NUMBER PROGRAM NUMBER
P40, __3_ of
M
3.61 (7'871 -25c NEW Yt,. STATE DEPARTMENT OF ENVIRONMENTAL CONSERVE. ,N
SPECIAL CONDITIONS
For Article 24- ( Freshwater Wetlands )
STATE ENVIRONMENTAL QUALITY REVIEW ACT
Under the State Environmental Quality Review Act (SEQR), the project associated
with this permit is classified as an Unlisted Action with the Town .of Patterson
Planning Board designated as the lead agency. It has been determined that the
project will not have a significant effect on the environment.
I
DISTRIBUTION
P. Keller
.Law Enforcement
R. Wood
J. Steeley
Laurent Engineering
DEC PERMIT NI
3 -3i
FACILITY 10 NL
ante sewerage System bout by .Address kR
Conelatlog of l d 0 Galion Septk- Tank and
ML
Water Supply: Public Supply From Address /,,
orr Private SaPPU ; Druled by �bl�Dr A T Sl 'Address �D �Y�' 5 -2 CAP- i�iL. N� )5I
g T,pe �9; ��T /'i, Has Eioslon'Coatrol Been CompletedY
Number of Bedrooms Has a Grinder Been lnetalledY
Garbag
Wier 'i egoirements 20M
I certify that,the syitea(s) as''liated`"serving the above premises were "constructed esaentiilly :ae.eh .on t pens of the completed work ( copies
of which are attached), and in accordance with the standards rules and•regq ationa in .accordance wi tii 1 pldn; and the permit issued by the
Wtnam'county,Do rtasent Of Health
Oats. /� CertlfNd OY P.E. R.A.
Address" f % L�canso
Any person occupylnq promises WVed by the above systems) shall piomoily take such action as may be necessary to cure the, correction of any unsanitary
t •condltlons.resuRin9 from such Y"e Approval of the srL r , a',aw a system'shatl Become null and YOId a soon as • pubtt9 unitary awe becomes
,.
avalNbla and tna approval of tDe ;privafe vvatsrsupply shll'become'n a void vvhan a. Ik ovate► wpoly' Becomes .wallabN. Such approvds are
sub)eet;to. ^rnv i %fieitio' or change "'when,': in'tM „►udgmenY; °of the C omr of Neal eh revocation, moalffeatlon or' change
! /I /Sl�Ll�nie�esary.
w.
Data l �. BY _ Title V
}
n.
,c��
WELL CuMYLLiiu►v ruxutcl
CI * DEPARTMENT OF HEALTH
Division Of Environmental Health Services
�� PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
-
WELL LOCATION
STREET AOURESS: WNI 1 TAX GRID NUMBER:
L'yi % P� Q 7`c-v L� Pal"b
WELL OWNERlG
N ME: ADDRESS:
Oh 7 �— �, avt_
S PBIVATE
O PUBLIC
USE OF WELL
1- primary
2 - secondary
&RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT_ gpm. /N0. PEOPLE' ERVED / EST. OF DAILY USAGE 5VO. gal.
REASON FOR
DRILLING
.[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH QS' ft.
STATIC WATER LEVEL---!2 ft.
DATE MEASURED 42,532
DRILLING
EQUIPMENT
O ROTARY 04 COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING ®...OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH ft.
MATERIALS: ® STEEL O PLASTIC O OTHER
LENGTH BELOW GRADE �-� ft.
JOINTS: ❑ WELDED aTHREADED ❑ OTHER
DIAMETER �— in.
SEAL: Ia CEMENT GROUT O BENTONITE D OTHER
WEIGHT
PER FOOT
Ib. /ft.
I DRIVE SHOE ® YES ❑ NO
I LINER: DYES ® NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (It)
DEVELOPED?
FIRST
O YES ONO
HOURS
SECOND
- - -.- --
- -..— -
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER j1nDOEPTH
OF PACK
P
ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED t tests were done is in-
1
tir,COMPRESSED AIR ,formation attached?
O 8AILE0 O OTHER ❑ YES=' ❑ NO
WELL LOG it more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
watcr
Bear-
ing
Well
0ia-
Meter l I
FORMATION DESCRIPTION
coot
It.
It
WELL DEPTH
It.
QUftATION
r min.
ORAWOOWN
It,
YIELD
gpm.
Land
(7
as-
os-
w� Y - a 10
u "
a c�-
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED? O YES ONO
STORAGE TANK: TYPE
CAPACITY GAT,.
WELL DRILLER NAME Z� j f� �� DATE
ADDRESS tG7`S� SIGNATURE
�J fu
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP
3/ tSy
see N®RT AMERICAN
-j - B IGS9- Cs - - -- -
CERTIFICATE OF LABORATORY ANALYSIS
LAB ID NUMBER: 97 -3233 RUSH!
CLIENT: Bill Byron
.7 Taryn Ln
Patterson NY 12563
SAMPLING LOCATION: Kitchen tap
COLLECTED BY: B. Byron
DATE COLLECTED: 06/18/97 TIME COLLECTED: 3:30 PM
DATE RECEIVED: 06/18/97
DATE OF REPORT: 06/19/97
ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED
Total Coliform Absent
E. Coli Absent
Must be "Absent' SM18(9223) 06/18/97
Must be "Absent' SM18(9223) 06/18/97
This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking
water quality for the tests performed, was:
ACCEPTABLE. _ NOT ACCEPTABLE.
Richard W. Emerich, Laboratory Director
NYS ELAP #11218
CT Lab Approval #PH -0171
* Underlined results are unacceptable according to health department and /or US EPA codes.
** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes).
618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 - 278 -7600 / Fax 914- 278 -7754 / E -mail: NoAmLab ®aol.com
e LAURENT ENGINEERING t
— ASSQCIATES, 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
July 16, 1997
Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS Compliance
Car -Dee Lot #7
Partridge Lane
(T) Patterson
Dear Robert:
Enclosed are the following:
1. Four (4) prints of Drawing S- "As -Built Plan ", dated 7 -7 -97.
2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 7- 14 -97.
3. "Guarantee of Subsurface Sewage Disposal System ", dated 6 -18 -97 & 7- 16 -97.
4. Well Completion -and Well Log Report, dated 6 -9 -97: -
5. Water Analysis Report, dated 6- 19 -97.
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.
Harry W. chols, Jr., P.E.
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