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HomeMy WebLinkAbout1084DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -1 -44 & 25.54 -1 -45 BOX 11 �, �I- ;- , •� . - , -; ; �r r Nil , • �, - , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT T PERMIT # 0 0 Located at Subdivision name p+N4 Subd. Lot # Date Subdivision Approved e �_o i no Owner /Applicant Name��� Town or Village PA5P -6DH Tax Map2b,15�i Block l Lot q)b Renewal Revision Date of Previous Approval Mailing Address ?495 OEPRIPP p 4D AFr 10 65WWO A1t,t,7 P Zip Amount of Fee Enclosed to Building Type eZ610tl*-� Lot AreaO -5b No. of Bedrooms ?7 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and tt95 Other Requirements: i0ftl e 5 To be constructed by Address Water Supply: Public Supply From Address or: Private Supply Drilled by' Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 5; [.�) 102, License # 561 Z,k APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public.Health Director. Any revision or alteration of the approved plan requires a new permit. A �_5h�a�r�eof domestic sanitary sewage only. By: rte: c�� /�. Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy.- Design Prof zonal Form CP -97 0 i i PUTNAIhA COUNTI( HEALTH DEPT 1 Geneva Road (845) 278-8130 - - Brewster NY 10509 v .Date � 'D;,Z -- , Received ofi 1 The S.urn © � �. Of. - Dollars � � 0 i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICESS _ APPLICATION TO CONSTRUCT A WATER WELL J �� - - /qo-� .....please print or-type. -.. .. - .. • PCHD Permit-# Well Location: Street Address: Town/Villa a Tax Grid # C.l HT'OH �E FAT1 e�60H Map7-6,54 Block I Lot(s) U Well Owner: Name: M J HRfC wVwE Address: 1�-%- DI F6 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought . gpm # People Served � -5 Est. of Daily Usage po gal. Reason for _ X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _,< Drilled Driven Gravel Other ` Is well site subject to flooding? .......... ............................... ........ ............................... Yes No . Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision P A H AYN I-p�J4,-' Lot No. Water Well Contractor: TbD Address: - Is Public Water Supply available to site? ................................:. ............................... Yes No X Name of Public Water Supply: '"— Town/Village ' Distance to property from nearest water main: -- Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: LM PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l� ©'2- Permit Issuing Date of Expirati G7 Title: c Permit is Non-TransfefrWe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL lj please print or type PCHD PERMIT # Well Location V u vv� llU%& vJa. 1 V W IL r ulagv i an vl lu rr C'AH1 p �1 � i O j�{ Map y "�`i Block Lot(s) 3r° Well Owner: Name: Addres : � Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well: 7X Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional . Standby Water Well Name: Address: Contractor: I Reason For NEW WEELU 'P? K O NU-N i 0 0F0-FH1_ '-R Wt TO Abandonment: _15 6TUI of Work To Be Performed: 5 W I Q1 Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. 66-t'e' 9KIssue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 4 May 31, 2002 Mr.. William Hedges, Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSDS - Ruggiero fkepair/Replacement Canton Drive Town of Patterson Dear Bill: Enclosed are the following Harry W. Nichols Jr., P.E. . Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279.4567 1. Five (5) prints of Drawing SS -1, "Proposed SSDS," dated 5/31/02. 2. "Short EAF," dated 5/31/02. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 5/31/02. 5. "Design Data Sheet." ..6. "Letter. of Authorization.'-' 7. Two (2) copies of Residence Floor Plan(s). 8. Review Fee in the amount of $100.00. . We would appreciate your review, approval and issuance of the Permit at your earliest convenience. Very truly yours, Harry W. ' INcl o ls Jr., P.E: HWN:JM:jmm 02- 040.00 14,164 (9193} —Tud a _S E Q R .. ... - PROJECT LO. NUWBFA _ • Appendix C ..: - . r _ State Environmental 6414 Rerliw' —_ -- _ -•. SHORT ENVIRONMENTAL ASSESSMENT FORM For UNUSTEP OkOTION8 0*.:-: PART I— PROJECT INFORMATION (To be oompleted by Applloant or Project sponsorl - :: 1. APPUC.M1T 4PON80R 3. PECT NAME— AO�o + JEHHtFez ���U ►�� ROJ��A r eal r rn� 3. PROJ ECT LACATON; . _....._ U P-��H Ca,nl,. . PRECt8E LACAMN "1 a4"" and road lnl~Uona, prominent landmark&, oto, of pro*e map) I S. I9, PROP06ED ACT11OW... q. > 0 Nrr _ .0 F�cparubn j.Wodl(laalloiVWlwalbn 75. 0 ESCRJ B E PROJ EOT BRI ULYI 7. "OQ HT OF UW D A"ECTEOC wwlry Q'(;,% aona Ulun*wy S aona S. YALL PROP48FD AOTiON COMKY WITH UJ=N0 ZONIN0 ORETHER EKl3TIN0 UWG U86 RUMOT1QW ycr�a 0 No If K deWW kwty ~ _ 9;.. T IS PREBr;NT LAND U8I.� VONO OF PROJEGR ga•►1d tw 0 ImduatrW 0 Commwolal 0 Aprloullun 0 Park/Fomuopan $Pao& 10. DOES ACTION INVOLVE A PERMIT APPROVAL; OR FUNDING, NOW OR STATE 09 LOCA147 ❑ Y" 10—,No U yµ ml apwirm and pmwu ppmws Y FROM ANY OTHER OOVERNMENfAL AGENCY (F-WERAt, t t DOES ANY A$PEOT 0(•THi AWW HAW A OURftI:IMY VALID PEEWIT OR APPRoym . ❑ Ya, !No . Urµ Wt+a)anoy parrw and pirallNapprvvatJ 12. As A AE8ULT , ACTION WILL E gme PEAWT (APPROVAL R.EOWRE tl00iFICAT10Nf O Y., 1 CBATIFY THAT THI INFORMATION PW'40E0 ABOVE I$ TRUI To THE 6E8T OF WI(NOWLEOOa ' \pj Applkar,vipor►�or nam« i E • A6 EH � . • oat« $Ipnalu�K t If the action Is In the Coastal Area, and you are a etsts agency, complete.iha .Coastal-Assessment Form before proceeding with this assessment I :RT II— ENVIRONMENTAL �. OQES ACTION EXCEEO ANY TYPED. MM914T (To be completed by Agency) - -- 617,11' . If yes, 00ordln4le'the revlew pr000" "'Tim rvt.�. :. wiu ACTION RECEIVE COOROINIITttD itaYt:YV A3 /ROVIOtA rjOfl VNUSTEO ACTIONS IN 0 NYCRR, PART 017,e7- it.-No. i negative deciuetlon may o4 superseded by +no".lnvoived aQetlOys , O Yes ONO couuo ACTION RESULT IN ANY ADVERSE 9FF9QTS ASi001ATE1)'WITH THE FOLLOWING.' (AMwere ff4Y be handwrllten,,Il 1191011) C i. Editing, air gvall(y, surI44 a grow4w4{}r Quell {Y a auanlily, n01ae levels, We* tn11.Ie_ pa)lagl, •90.10 weste Pf°ductlon a Wspwal, . pot.nu lot ero +ton, dmlruw a hooding 0OWW47 Explala bristly: C2. Awncic, agricunurall,ucnaeologlcaJ, hlatodo, or other nalvrel or cultural resources; or community or naight)Orhood chaiacter? Explain brlelly; C-3. V.gglalion or fauna, Ilah, shelltlsh or wlldllls species, significant habitats, or threateneo or endangered "lost Explain Wlelly; ;,.. A commvnIIy'i sxIitIng plane or 90411 111391`1101911y adopted, or a change In use a Intensity of vol of tend or otMr nattlL 1116"I'M1 Exp0ln txleUy 010win, &Voapu•nt der•bpmenL Or related aotivltla Ilkely to M Indvoed by the proposed eoUonl Explain trlelty, :,a. ".nq l.rm, snort term, c wwWye, or other eflsow not IdanUlled In 01.061 Explain Wally. ...._. . ..... C1. Olney impala (Includinggcchw H In use either Quantity of type of energy)? Explain brlefly, . btu THE PROJECT VE AN IMPACT ON THE ENVIRONMENTAL CHAMCTEASTICS THAT CAUM TH9 UTABU8HMENT OF A CEA1 n Y.a p 5 TnEAE,;O 13 THERE UKELY TO 8E, CONTXYEMY. RELAT TO POTENTIAL A0VER$9 ENVIRONMENTAL IMPAM I� Y.l . /�No It Yes,'explain briefly T III — DETERMINATION OF SIGNIFICANCE (ro be completed byIAgency) NsTRUCTIONS; For each adverse effect Identified above, determine w,helher It is substantial, large, Important, or otherwise significant. :acn spec.' should be assessed In oonr►eotlon with it+ 0) Ntting 0.e. urban Or ruralk.4probablllty ot.00gyainp :;(oj..4V.(411on; (d) 'rrver4101111y; (e) 9e90raphlc GOOK and (Q magnitude, If ne0vaaary, add attaoMwit or reft+ronoe eupponing materials. Ensury that ;Pianatlona contain wiflolent wwj to show' that ail relevant adwne ImpaoGl hive belly.' Identifled,and,adequately addressed. If ueatlon D of Part II was 01`1e0W yea, the determinatlon and slgnifldance must evaluate the potential Impact of the proposed action n the eny1ronmenI&1 characterletlaa of the CEA, , Check this box If you have Identified one or more potentially large or slgnifloant adverse Impacts which MAY occur, Then proceed directly to the FULL EAF and/or prepare a positive declaration: Check this box If you"have".dstermined, omd on tbo Information and analyils above and any supporting documentation,. that the,propos;ed notion WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination; f4 *r in ^�Y turf of [jn V44 #unrY-'�^ iWn16T - ?fi�v Ice r (we of rmwe( pent Imm tespons i o r< PUTNAM COUNTY DEPARTMENT OF HEALTH.'.`. DX SION:,:OEr EN1VIRONMENT�AL= HEALTH ;SERVICES — APPLICATION FOR APPROVAL'OF PLANS' FOIE �+ A WASTEWATER TREATMENT SYSTEM. '1. Name and address:.of.applicant.' .. •.�... .... .. .: / —.... DEDFOR-k- PLO.' y Itt� ` + �,'•' :fir': �:. 2. Name of project: '' 1 �' �) . Location T/V p 7�] C �' : ► 4.. Design Professional: ��� �'' ` til`� oVS& Address: Vq 0 6. Drainage Basin: Ps �l C.i�.. .�' :!f`,=�� a.: 7. TvDe of Project:;` . .. , ..• ...... ... ..... ..... . Private/Residential Food Service .. Apartments.._..::.._ ..............Institutional - Office Building Commercial -:•- -; , •::}: -. `•'1, Mobile_Home Park.,, Realty Subdivision.. Other(specify) _.._ ....... ......... ..._ . 8. Is this project •subject to State Environmental Quality Review `(SEQR) ?' ' .: _ .. , _ ° =,::.TTYPe Status.,(check on :..;.... ......: . YPe °I Exempt•. =: ' Type'II= a Unlisted i 9: Is a Draft Environmental Impact Statement (DEIS) required? ......................... .. �'' 1. .. i:: ii •ref: ° t,iU.i 10. Has DEIS been completed and found acceptable by Lead Agency?... 11 Name of Lead Agency ' t p. — 12 Is this prod ect in an area under the control of locarl planning, zoning, t inii . t ` :. � � {:�� , 1 �: � 'f� 't•,, -. f ,. III. • �, - r•1' i t ' .. .11 'If so, -have plans been submitted to' such authorities? ...:. .. -14.: Has relimm rov 1, been, anted.b • such authorities? N ODate� anted ' p .'Y� aPP.... y g?' . .•. � ', I 15. Type of Sewage Treatment System Discharge.........::...... surface water X groundwater ;16. If surface,water, discharge; what isl the stream class designations ........ 55 _• t. , ' _1 .•. j ',.t rt }•. t t t:.l l ' {�. ,'.) - 1. $J•Y � A�..ILLi:J \.iiilli - .�.,.. .. ,: �+ �i� ;} ........................ t X 17: " Waters }iuidex number (surface) ..... , ... • .... ..... , 18. Is project located near a public water supply system? ............................ •i. t: f ''• :: ' it it {.:••••'i ��: 11 ��.. a } }•: t 1 1 r • ..i 19. If yes,'riametbf Water supply N Distance,to;w ter�supply�:► �il ;iti \tl�t�l.l it. 1.1•ll Tlv1l :i:.: \� n .I'1 .y , 20. Is project site near;a`public:sewage collection or treatmerifsystem ?" ........:::.'� 21. Name of sewage system. ` ` Distance ,to.'sewage'system'4` 22. Date test holes observed 5 1,� 'L- 23. Name of Health inspecto r _........_..._..... _ _..- 24. Project design flow (gallons per day) ......................... ................ ._ ....._...... .. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ........................ Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetfarids ID Number ......' ....................... ............................... ........................... ..._ _...� 29. Is Wetlands Permit required? .............................................. ............................... NO Has application been made to Town or Local DEC office? ............................... N 30., Does project require a DEC Stream Disturbance Permit? .. ............................... Q 31. I's or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, Ian-dfilling, sludge application or industrial activity? .. Yes/No N 9 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... j. 34. Are community water and/or sewer facilities planned to be developed within 1 years in or adjacent to project site? ............................................................... N 0 3�. Are any sewage treatment areas in excess of 15% slope? . ............................... _0 _ 36. Tax Map ID Number ........................... ............................... Map 66;5 Block Lot 37. Approved plans are to be returned to ..... Applicant Dzsi,gn_Fwf, s.ai.auad NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shah be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities Cron:- DEP and submit those forms to DEP for review and approval. I f the application is signed by a person other than the applicant shown in Item l .,the application m.!St be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 1 hereby affirm, tinder penalty of perjury, that information provided on this form is trite to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pttrsttant to Section 210.45 of the Pena) Law. , SI G,NA T URES & OFFICIAL TITLES: Mailina Address: ................................... oS- 0 27, 5V- PUTNAM COUNTY DEPARTMENT OF. HEALTH _.., DIVISION-OE ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address ... Located at (Street) G F *(\� Y-0A\j4tM Tax Map'y ' Block Lot Not A'AK (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre - soakin g �' Date of Percolation Test l b :. Hole No.. :;....:.:... ...Run.Np:' Start <Slop :: Ela se Time rplVlin.) Depth to Water From Ground Surface (Inches) ! Start Stop Wafer Level Dro In pp ;Inches Percolation Rate midAiA 2 3 1 15 1b Wl, Wq" 4W1 .2. 9 - 3 ( 001 4 5 1 J 1 2 -- 3 4 5 _.. NOTES: 1. 'Tests to. be repeated at same depth until armroximately equal aercolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level. at which groundwater is encountered -- Indicate level at which mottling is observed - Indicate level to which water level rises after being encountered 04V Deep hole observations made by: }% ft1 (�-�� Date Design Professional Name: RA �Jo f�liJ6�0�5 Address:S0 22 Signature Design rrotessional's Beal �OF NEW y yA� ! N1 a No. 56124. oA9�FESS10��� FtM PUTNAM COUNTY DEP ARTMENT OF HEALTH: --DI-VISION- OF-­ENVIRONMENTAL HEALTH -SERVICES,-, LETTER OF AUTHORIZATION Property of HAVO Located at Cif -\oH T/V Tax Map # Block Lot Subdivision of p Jr L 1, v. Subdivision Lot # Filed Map # Date.Filed_ .Gentlemen: This letter is to authorize M H 1 &1+0(-6, J�- a duly licensed Professional Engineer or Registered Architect to Apply for the. yeqq4,rqd'.'.,., wastewater treatment and/or water supply permit(s) to serve the above - noted - property in accordance with the standards, rules or regulations as promulgated by the Public Health Director 0f -tfi`e'it.PuW'am"ll1 County Health Department, and to sign all necessary papers on my behalf in connection '.�w'ii -this :..matter and to supervise the construction of said. wastewater tretment and/or water supply systems .in. . co . nfoiffifty with the"' provisions of Public HiAlf'; Law, and the Putnam Code. NICHO Very truly yours, Countersigned: 0 .. 1W -P.E., R.A.j o. 56124. sit N E Mailing Address - State zip p©Gi Telephone: Signed: _ (Owfi-er,of Propetty) Mailing Address:. A rl (L) Lj N! V. State zip Teldph6ne: Form' L' Harry W. Nichols Jr, P.E. Patterson Park, Suite 106 2050 Route 22 ---Brewster, NY 110.509 - (L945) 279-4003; Fax 279-4567 CONSULTING SITE ENGINEERS JOB No. SHEET No. 1 OF COMPUTED'BY:-*.,,-.-*.JM- - :-:':;-�-.,-.'..' D ATE CHECKED BY -DATE . .... . ........... -17 A M C- EA 1) 1 IRL)' ------------ _LV,&4Z T_ PIPEL L-F TO h ry .... ...... _e _-_P),PE.� . . ............ .. LL .N .T _J4 TO h ry .... ...... Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 . - Brewster, . NY .10509.... -- (j 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEERS JOB No. K -0 qv SHEET No. 2 OF 2 ...... _.... COMPUTED B.Y -._ . ,Dpi _ -. - - : - - -- DATE -.. , -.11 CHECKED BY }i WA DATE 5'TE M VmUmE 1 ' (?Q X_7 LJF 5oQI eP� - - - -- . __ ZDa5f- - ERFIF AIR 57PA — - - -- - -- - _ -d NE Df�-? STORA&M BOO C-44" � . - - -� - - - -- - -- -- -- - -- -- — _— --p Q & P 0 jq — -- �'- .. ;n � - ---- -- D A - .... — . ........ _ - - - -- Verformance Curve METERS FEET 16- 50 14- ** ­ 40 12 - ug 10 — MODEL 3887 30 - 8 0 20 6- 4- SIZE 2" SOLIDS 0 2- n L 0 (VO 40 60 80 100 IbU 180 GPM MODEL 3887 SIZE 2" SOLIDS WIN MOM willIn F, I Nil .1 (VO 40 60 80 100 IbU 180 GPM di SewaG umn! ral �ouigs MODEL . 1 k•§ .s .' d � w �i 0 t ,� rw II ,+ v Goulds _ ubmersi .- __. Sewage 7' ``• 5 6 amps ( 'BHF„ _! Models 2; 3 r "B" Models 3887 4 x j ' ~ X ,' m s R.O. : 2• -0• r '..?# ' 8' -0' R.O. D' % 7' GARAGE DOOR SUPPLIED w S S 7 0 2 A O AND INSTALLED IN FIELD BY BUILDER 1 x17 GARAGE DOOR SUPPLIED qs� y , m � Z � � MIDiMSTALLED IN FIELD BY BUILDER �' S� �{ 4xm- gg �i �z0� Vii: }•2 Illt�, 7'Sliai ZO-i1 �rcIm�1 ..1:.12'' I C' -•1 T. B� ;I'1 .4 2 iaN 1, Lr r ♦ut I 1 �'f= 3�, ago rnog Ate'' '�' • 5.'�'+i ' b +`• 0 Ott` to a i9kSl4S'k r a 4 cmC • ak a t n4h; z ° AAA �A —. I Pa AAA o R 1 O m Z= 4 at 3 i vm Xk • #�-. ,F VBA2 Aq 11 ri WSEts � -..... SPACE P P P!!• NA SS G Pi L J�y FM p J' -W ELPT ARCH 0. O a n- K•LKbaktiKKKYN h all r, Fn. m b Q{ ay 8;•, 1 1- 0'II -ELIPf MCN r•%•1 R?'�: Zi JL at S b a my 41 N p M I.� p 2r -r + IMORTMM. HOME TECHNOLOGY INC FLQOR Fi! NN STREET s2ss tEL (015 BS8aY N.Y. 12771 FA%: iB�S) 858 =2/BE I }., ,BBfZ -BSB B ozi 99 --UL i Lun wN 'SI AMr lM°d d N; n ' 00.� Nfl aN003...; SOH V Y N, • „N Q g g L � M x9IOAioaL S allflL� a • .t -.ta °z Z9fZ p > Z Z I� o U °a ” tu �m o� I 44 � 4V �J y j C K yg�I y�g1 ocaA °reA v fill tq V, HOUR WNiS /M am N „7 �� �hh1.�T�fihbk hlV lr :. in ilV Rig use In N 1B� I v�yi p q (7 In, jg HIM � S o a = • K <OS t S O 'g�`�rq� n .1 / �aNO t .J. .9 RR nd °• S W G � C i-O— sq qq ss OR V INS, � W 9• co aa X X 9 m � PPt v _ D / ul CA TA Pep L- - - --- / 11 •�/ ' / i i l/ // w i d NZ I 100 O N I b-V Z o �� I N 1 •_ I N I. to I �� xx I 10 `y Io tv / �� ' / If I // IV oto 01/1 \ ilI 11/ loo / / wl l I 1" / Z PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL..HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #' ��' '��-r r1T Located at �� C��H��� it l Town or Village T 1 C' Owner /Applicant Name W- 4 J cH" 6� - IZ4 4i" Tax Map ' �� Block +�_ Lot -44 Formerly Subdivision Name Subd. Lot # Mailing Address i-46 BOPt" P-k)A® Ari 1 D cfl 'PH Ll,6 K Zip 1 y -5 11 Date Construction Permit Issued by PCHD Separate Sewerage System built by J AnE 6f&ILANN I Address �1 Consisting of i o 00 ' Gallon Septic Tank and. AL T-F-5 HC4 Other Requirements: �PYy Water Supply: Public Supply From Address or: X Private Supply Drilled by . ss ,15- Pmfx'Ne FAAS te, AKA Building Type.. .y i.Dir1-6JG Has erosion control been completed? 5 ..........._ ........._......_.. Number of Bedrooms Has'-garbage grinder been installed? I-A I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulation of the Putnam County Department of Health. Date: 62-116 ! 01) Certified by P.E. X R.A. (Ues�h Protessionau. Address ��"o yJA 'N� 1 1) 17 0°'l License # �0 0--4 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null'and void as-soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modificatio or c ge is necessary. By: Title: Date: - p White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design P fessional Form CC -97 PUTNAM COUNTY DEPARTMENT OF H DIVISION OF ENVIRONMENTAL HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMEN' Owner or Purchaser of Building Tax, Map Block Lot 1✓L1 H-r 1.4H 6v? Building Constructed by TownNillage G-1 CAS 10H ��►�1�I i Location - Street Subdivision Name P-45/t)1 PaH6 Building Type Subdivision Lot r. I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and f� that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition t, any part of said system constructed by me which -fails to operate for period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused-by the willful or negligent act of the occupant of the building utilizing the ..-system. ALTH ERVICES SYSTEM 1 44- The undersigned further agrees to accept as conclusive the determination of the Public Health x Director of the Putnam County Department of Health as to= whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing'the system. Dated• onth Day Year Signature: Title: Cl p Y eral Contractor (Ow der) - Signature A Corporation Name (if.,corporation) Address: �)j 6N(T�� P, P.A -YbOL-4 State N ey-) Zip Corporatiop Nan Address: State Nj6VN (if corporation) nF, r Zip 12-5 �I Form GS -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 •'2050 Route 22 Brew§tei; NY 10509. Telephone (845) 2794003 F-(845)279-4567 February 10, 2003 Mr. William Hedges Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Ruggiero 67 Canton Drive Patterson, N.Y. T.M. # 25.54 -1 -44 Dear Bill: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built Plan", dated 02- 07 -03. 2.. "Certificate of Construction-Compliance for Sewage Disposal System" dated 02- 10 -03. _. i ....... -_. .. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System," dated 02- 10 -03. 4. Laboratory Report, dated 02- 05 -03. 5. Well completion report, dated 02- 10 -03. 6. E -911 address verification form . Kindly process the enclosed at your earliest convenience. Very truly yours, Harry W. Nichols J ., P.E. HWN:gav 02 -040 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 67 Canton Road Town/Village: Patterson Tax Grid # Map2&'51Block 1 Lot(s) Well Owner: Name: Address: James Kennedy 45 Woodbine Street - Yonkers, NY 10704 Use of Well: 1- primary 2- secondary --- Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other. Casing Details Total length 4L ft. Length below grade 41 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: )L_ Steel _ Plastic _ Other Joints: _ Welded X- Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: X Yes _No Liner:_ Yes _ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes . No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield a. 1Npm Depth Data Measure from land surface- static (specify ft) 10 During yield test(ft) 300 Depth of completed well in feet 365 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 20 hrown Sand Gravel 20 365 Grey If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 365 9 1/2 Pump Type Sul,, Capacity < < ,.,.N Depth 30(bTNERS Model 7CH 104/Z Voltage 2.30 HP 1 Tank Type Wlf =3o2 Volu a (.P- Date Well Completed 11/26/02 Putnam County Certification No. 2 Date of Report 2/10/03, Well Dri r (si re) NOTE: Exact location of well with distances to at least two permanent lannmarxs 7roviaeu on a separate snovu}nall. Well Driller's N, L DRILLING, INC, Address: 75 Putnam AvP_, RrPwctPr, Y Signature: Date: 2/1.'0/03 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Client: James Kennedy Zip: 10509 Fax: 845 - 279 -5075 Collector's Information: Name: Russ Address of site: 67 Canton Rd City: Putnam Lake State: NY Zip: Telephone: Sample's Information: Site: kitchen tap Date Collected: 2/4/03 Date Received: 2/5/03 Preservative: HNO3 Time Collected: 15:30 Time Received: 16:00 Temperature: <4C Lab No.: J030597 Date Analyzed Test Name Result MCL Method 2/5/03 16:00 Total Coliform Absent Absent SMWW 9222B 2/5/03 Chlorine Free Residual <0.1 mg /L N/A -SMWW 4500CIG 2/6/03 Color ND 15 Units SMWW 2120 B 2/6/03 Odor Nb 3 TONs SMWW 2150 B 2/6/03 Iron 0.030 mg /L . 0.3 mg /L SMWW 3111B 2/6/03 Manganese 0.059 mg /L 0.3 mg /L SMWW 3111 B 2/6/03 Sodium .12.4 mg /L N/A SMWW 3111 B 2/6/03 Chloride 56.0 mg /L 250 mg /L SMWW 4500 Cl C 2/6/0 .. ..: 3. ' . :.:. ..ardness :....� . -� .._ .. _ .. H 156. m - - g /L- 2/6/03 Nitrate 2.62 mg /L 10 mg /L SMWW 4500 NO3E 2/6/03 12:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 2/6/03 pH * 6.15 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 2/6/03 Sulfate 24.3 mg /L 250 mg /L SMWW 4500 SO4F 2/6/03 Turbidity 1.95 NTU 5 NTUs SMWW 2130 B 2/6/03 Lead 9.77 ug /L 15 ug /L SMWW 3113 B Comments: * Below MCL At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max: Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter „ ND- None Detected Signature. State #: PH -0218 Michael Lapman ELAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com DEC -18 -02 02:11 PM TOWN OF PATTERSON 9148782019 P.03 ' •• I ' �� r .r.rr •.. .dry -__.r • .. r.. . . t `T� 9RUCb ;� i4LBY . r LOMTA "MOLD"`LK, KS-N- . AAA, DL*Uiw APM W P Wa N1dik Dtnrhr D6tlta 4f Fe" Stm w -. - -- �DEMAA'i MEW OF HEALTH • � •• 1 Omit Road _ .... Orewstor, New York 1009 Z.rsrw�u�w >1t111fi pl {11It •f170 tulpl <) sfl•t1i1 -� _014) 3111011 WIC 014)37i•iifl '.tapl {} 31t•i413 ` '�+++r "1>Glrvii�8��(slUtii�601{ rrinkQ0 01917 O rapt4ai7r,6w1 E9, 11 ADD$R,4S V ,RIFICaTTU FN ORM owft S NAME; TAX M�? NUMMRI E911 ADDRESS: 7 G ofl} -# oA Dp l V TCV iN, DM AUTHORIZED TOWN OFRICIALI DATE: 101VA F The Putnam. County- Departm at of Health. wig„ not. iaSu>�.a_ a Cate of - _ ...... ..... ...__'._ ... _.._ _. - Cowirucdon-Compliante unless the above iorw !o completed* Le., a legal E911 address is a3siPed by ari sutborked town oftM L •T h form is to be submitted i with the application for a Certiticute of Construction Compliance, • -t r 1 i 'e Nw O 0D �K15T• WE�� V a0 AD R m 0 / / 0.34' L 73.g b; s .3 I WA`/ D.f b �o. A /Ob, n 7 y/ �JW � 9 , Pe /"h 0 00 i c � 3 � •l � S 31''25" Cr QJ \x p \% 52 \ 4 9.14' /q dMoo 'B0.08 q � ° — — Q � v W .. .........:. � - -„ �.. _ ... .... :..._ .._..'... ... _. ._. _. .. .3821- ... Ago IA 0 \ 1 i "�" a O 1 EXISTING 3 gQ 1 ttES I D1rNGE C. 1. P....1 1000 GAL 1 SEPTIC TANK /3 1 �90?41P CHAMBER iP �y 4 b \ "� SOLID P ✓c 5DR 35 W O U� EXIST. W EL \ --Me on. z 30000000 R Y 296.90 L = 92.4g' � 3S•53 ►oo w \ CANTON DIMENSION CHART -(in Feet) Number : A B 1 24 23 2 28 21 3 123 145 9 121 144 S. 116 139 6 1 10 133 7 103 126 97 121 9 91 114 10 95 109 1 1 79 102 12 74 97 13' ?5 96 14 96 103 15 92 log 16, 00 116 17 108 12$ IS 116 130 19 117 133 20 1 19 138 2 1 122 137 I I �o