HomeMy WebLinkAbout1410DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
33. -2 -32
BOX 13
01410
.::
,`
z
L�T
01410
PUTNAM COIIN'!'Y DEPARTll1EIWT OF HEALTH
Dkidn ef Esvhaaseaid Had& S, 11 CutmL N.Y. loSl? Rimikow to Provide Pack if
PEB W FOR SEWAGE DLSM" SYSTi
- - "S vlaliw Elile's 11Y y ke - Lst a M
er TE OF CO -
pkrralt r
owu VFdtaBo Tom M4
Renewal_ ❑ Eevbden ❑
owndAppYcaut Nave f- �Y/�.4i►'1 /i� Grl. � 7'o�E rr_�,P.a
Date of Pmvbm Approval
N A18eo`;J�p n7� �i� Two, e::Xaikli1 -2A/io zhi 1a517
Date Subdivision Approved Fee Enclosed ® Amnnnt 64,a11
Beillilling Type /�FSiDFiil7`sA� —Lot Ales Fm Section Ody Li Depth volume
Numbee of Bedrooens 3 Dea1V Fllow G P D 400 PCHD NotlBcadon Is Repadmd When FM V completed
Sapseste Sewa ng Syl*m to cwwm of Loan Gapgu Sepdc Tmk and 42204-65 A45 7;_e1+C,,;4.00'
To be caedlucted by 72/2 Adlheaa
Water Sapp: PuNk Supply Frees Add r
an �C _Pelrate Supply Drilled by j_9—/> Addren
Other Requhameeds
1 reprosent'.that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules aea regulations oi—1 ulna —m
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Haalthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that mid bulkier will
Dlece in pod operating condition any part of old sewage disposal system during the period of two (2) y s Immediately following the date of the Issu-
ance of the approval of the Certificate of Construction Compliance of h 'original system or any repairs eto; 2) that the drilled well described above
will be located as shown on the approved plan and that saki well will be inst in accords ce wit sta ds, s and rpu a � ons of the Putnam
County Department of Health.
Onto l _ J �7 6 Sighed P.E. _>Z_ R.A. -
-� Address ).�� -onka_ D� � x ?'-P' i i Y License No S4
APPROVED FOR CONSTRUCTION; This approval aKpires two years from the date i ed unless con ct onr tro building has been undertaken and is
revocable for cause or may be amended or modified when considered necessary nor of Health. Any change or alteration of construction
►equires.,a, w per mit. Approved for disposal of domestic sanitary e
Rev.
q /99
10f 88 wee Title �i2 G T � J
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATIUN--'`lO"'CON$TRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address Village City Tax Grid Number
WELL OWNER
Name
v
Mailing Address AIr
Q c)
®Private
O Public
USE OF WELL
U;- primary
2 - secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
D ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT gpm/ # PEOPLE SERVED 3-4//EST. OF DAILY USAGE _,600 gal
O REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION M ADDITIONAL SUPPLY
2 NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
Nr t c
—
WELL TYPE
DRILLED
® DRIVEN ®DUG ® GRAVEL
® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: `�— J+,&VP� 0,4.yS _
Lot No. �fl�
WATER WELL CONTRACTOR: Name T is Address: _
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _"k'_NO
NAME OF PUBLIC WATER SUPPLY: /t��,¢ TOWN /VIL /CITY _
DISTANCE TO PROPERTY_F40M NEAREST.WATER -MAIN:
LOCATION SKETCH & SOURCES OF;CONTAMINATION PROVIDED
)WON SEPARATE SHEET J
(date) ( nature
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt3- (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:7`''�✓ '� 19 _
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
RANDOLPH W. LAURENT, P.E.
HARRY W. NICHOLS JR., P.E.
Januaiy 15, 1996
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS
Pyramid Custom Home Corp.
Jennifer Lane
Lot 18 Windsor Oaks Subdivision
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
LAURENT ENGINEERING
ASSOCIATES, P.C.
i, :L::k rQKE UFF'iCE,CEN'I RE=
Route 22 & Milltown Road
Brewster, New York 10509
(914)278 -6108 - (FA)O 278 -2658
CONSULTING SITE ENGINEERS
1. Three (3) prints of Drawing SS -18 "Proposed SSDS -Lot 18 ", dated 1- 12 -96.
2. "Application For Approval of Plans For a Wastewater Disposal System ".
3. "Construction Permit for Sewage Disposal System ", dated 1- 15 -96.
A., " Application to Construct a Water Well ", dated 1- 15 -96. -
5. "Design Data Sheet ".
6. "Letter of Authorization ", dated 2 -8 -95.
7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ".
8. Affidavit - Corporate Owner Application, dated 12- 20 -93.
9. Money order in the amount of $300.00, review fee.
We would appreciate your review, approval and issuance of the Construction Permit at your
earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nicho , Jr., P.E.
HWN:bd
95011 -18
cc: Mr. J. Mirra w /enc.
l� •C7•'z' �7'.P,. N� C O U' N''.7C''X" � E P ,A. R'z' M � N T O �'. , )� >E.A. X.. T �
APPLICATION FOR APPROVAL 'OF PLA14S FOR -A- WASTEWATER DISPOSAL•'SYSTEH
Name and Address of Applicant: G,J,5=v
mx
2. Name of Project: 3.— Location V /C: 7-422, nny
4. Project Engineer: Zl . ,K LL/_ ./✓,�;,y��_- Yom. �.r—_: 5. Address: Nillbrooke Office Centr
Brewster, NY 10509
License Number:_ _S6i2 Phone: (914) 278 -6103
.6. Type of Project:
_ Private /Residential Food.Service ..- .Cocinercial ,
Apartments Institutional Hobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject'to �tate Environmental-Quality Review (SEQR)?
T oe Status (Check One) Type I.. Exempt k,
Type II. Unlisted.
8. I8 a Draft Environmental Impact .Statement (DEIS) required? No
9. Has DEIS been completed'and found acceptable by Lead Agency?. N /,4
I Name of Lead Agency /,q
11..- .Ls_th is. projp:ct.:i.h --a -are under the ;er,trol of kcal planning,- coning;
or other officials, ordinances? ............ ............ ............ lV,,
t2. 'If so, have plans been.su�- -4ted to such :author.ities? .......... ........ A/A
13. Has preliminary approval beep 'granted by such authorities? iY,4 Date Granted:
14. Type of Sewage Disposal: System Discharge....... Surface water X" Ground Waters
15. If surface water discharge, what is the stream class designation ?........ ,A111,4
:5y Waters index number (surface) ........................... ,. A/1-4
�. Is project located near a public water supply system? .................. ALI
3. If yes, name of water supply _ �Sl� Distance to water supply MIA
9: Is project site near a public sewage collection or disposal system ?.....
Name of sewage system A1/41- Distance* to sewage system
(• Date observed: 23. Name of Health Inspector:
Project design flow (gallons per day) ..................................... �Q�
25. Is. State Pollutant Discharge Elimination System (SPDES) 'Pe rmit required ?.._�,
26. Has SPDES Application been submitted to local DEC Office? ...............
27. Is any portion of this project located within a designated Town or State
wetland? ......:.. ............................... /VV
23. Wetland ID Number ........................ ...............................
29. -Is Wetland Permit• required? ...............................................
Has application been made to Town or Local DEC Office? .................'...
30. Does project require a DEC Stream Disturbance Permit? ................. %VCI-
31. Is or was project site used for agricultural activity involving application
of pesticide* to orchards-or other crops, solid or hazardous waste disposal,
land-Filling, sludge application or industrial activity? ........ YES'or NO %L6
32. Is project located-within 1;000•feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known-source of contamination? .....'........:.YES or NO
DESCRIBE:
33.
Is
there a local master plan or file -with the Town or Village? ........ ".
yes
34.
Are
community water, sewer facilities planned to be developed within 15
years? y�Gti�
35...Are
any sewage disposal areas in excess of 15- slope? .......................... lYo _ --
36:
Tax
=Hap ID number ..... .................. ...............................
33. Z - Y Z
37. Approved Plans are to'be returned to: ................. Applicant _ Engineer
If the applicationlis signed by a person other than the applicant shown in Item.1, the.
pplication must be• accompanied by•a Letter of Authorization: Failure to comply with this
provision may be grounds for the rejection °of any submission.
I hereby affirm, under penalty of perjury;• that information provided on this
fo(-,,7 is true to the best -of cry knoxle -ge and be 1 ief. False sta'ter,ents made.
herein are punishable as a Class A Hisder,eanor pursuant to Section 210..45 of
the Pena T Law. A
>iGNATURES & OFFICIAL TITLES:
Millbroo.V Office Cent
'AILING ADDRESS: . Brewster, NY 10509
18
_ PUTwe m COUNTY DEPARTMENT OF HEALTH - - -- ,
DIVISION OF ENVIRONNOMI, HEALTH SERVICES
DESIGN - .DATA; .S T- SUBSUFAC . _SEWAGE DISPOSAL SYSTEM. r, _ �e�. : F
nF = �r P Address D
Own K.z�! �I 117 G �ST� . ;1 F IG� it Cam'
Located 'at (street) sec. �. Block � Lot =2
(indicate nearest cross street)
Municipality I�,��-(�1r'` "�,'i
Watershed
SOIL PERCOLATION TEST DATA•REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking
Date of Percolation Test
HOLE
NUMBER CLOCK TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water Fran
Water.Level
No. Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min. —Start
Stop
Drop In
Min /In Drop
Inches Inches
Inches
a 40.o
4 SDI L �' � - T ✓ 21-A
NOTES: 1. Tests to be repeated at same depth until ..approximately equal- soil -rates
are.obtained at each percolation test hole. All data to be:suhmitted
for review.
2. Depth measurements to be made frcm top of hole.
rev. 9/85
mk
TEST PIT DAT7 EQUIRED TO BE SUBMITTED WITH A ICATION
DESC JPri_✓N OF SOILS ENCOUNTERED IN TEST rtOLES
DEPTH HOLE NO. HOLE N0. HOLE NO.'
TO Poo I L,
1'
2'
3' LOA
4, GL AY
5'
6'
7' .
8'
9'
10'
11' -
121
13'
14' ...
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH LATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY:- DATE:
DESIGN -
Soil Rate Used ,o Min /1" Drop: S. D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity I 00,, gals. Type CONG
Absorption Area Provided By L. F. x.24" Width'trench
Other ✓%` p N E Vj
" � N • n;e � _
Name Signature
Address N� I M �_ :;' %E lJ�f =iG tG? -_r -j SEAL \\
1,
Pao. --6724
� ► �sTi -K I-j `( r �% Q� FMS SAO N
�,.�
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft %gal. Checked by Date
..,._... _...... e.,.. .r... ._�..a,r _- n-- inn.--. .+_. : ea��a.- ria cb:-' SUZC^ v3�- n- : ^•3- a:- :qK�:!'.:�:.- :._..: �:i�:c�..�X".:.�.•;.,::.^�^.,.: �a��.. Y� `,,Z^'.."`..+.".:r+•4:�- �-.;- ... .... .. - _..
pt `a"u`i COUNTY 'D. PART. LENT OF ALTH
DIVISION OF ENVIROI.*IENTAL HEALTH SERVICES
Date.:
Re : Property of-
Located at en'? P? Ip
(T) A 1(ey� Section S3 Block Lot t
Subdivision of %✓c, �ilY ���c
Subdv. Lo ;1 j� Filed Man J1
Gentlemen:
This letter i s to authorize Marry %✓ /l�ia��ls V �,
Date
a duly licensed:prdfessional 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 faith tize standards, rules•
or regulations..as promulagated by the Commissioner of the Putnam County
Department of Health', and to• sign, all necessary capers on'my :beha_1 f. irn
connection with this matter and to supervise the construction of said
_ sy.steri. ox:sys.tems,. in. conformiL-y with the prov,isi:oizs of Article 145 or -
1-7, Education ,.La.oz,the •Publ'ic Health Law,, and the Putnam County Sani—
t a r y Code ;, 1 ,� !
�-1 Very trLlly yours,
it z EI:.`'_ -`!,�' •I ` � ,! •
.5
Countersigne OA�'OF .�;J�.0�'�
P.E. , R.A.
Millbrooke Office Centre
Address
$rewster, NY 10509
914- 278 -6108
Telephone
Signed C
of
Address
�
t ClI c- Ro 4l
Town
Property ;
n
co, p
Cro �-ti• O �►dl �. l � S� I
Telephone .
Fiarnan �,u T3epartment a TleaJ th
Divisior; fi ,vironmental Sanitation
AFFIDAVIT - CCO✓RPORATE a4NER APPLICATION
_._... ,FOR ,PE_RMIT, Ap.PLICAT•IONS- SL1BMT- TTjZD-. -?' ;0-
- PUTNAM COUNTY HEALTH DOARTMENT
T0: Commissioner of Health - In the matter of application for _
C/
X, — ----- .-- '_-- _ - - - -' — _. —
— _ _, represent.
that .1 am an officer or employee of the corporation an d am authorized '
to act for, _ Rvr--h-iid . _ _ - —
(name of corporction —
having offices at _fJ�(�'_Gc� _(�,CDi'Y)vN� ��% /v�'
Khose officers are
President — �CSCf/� —/ i /ll2' _ 3 n%i {?L� UuJ �,ecirJPv•�� y
-(Name and Address)-'
Vice- President _ _ _�i4 ,_ — _ =
(Name and Address) — — —
Secretary - - -- —_. -- — -- — — — — — — t - -
_.
(Name and Address) `
measurer' ��_ _
— — — _ — _ -. — -- (Name and .Address)— — _ _ .
r •
and that X= am-and w';L 11 be individually responsible fon any' or all aptp
of. the- corporation with respect to the approval requested and•all .sub-
,
sequerit acts .relating -thereto.
c,; or n-_' to *be fore i,e this day Signed
of _ E � Abe L-. 19Cj Title
Notary Public,
Boni rr_ J. 0 %'rs
Corporate Seal.
1
Y
i�
T�
wl k5
..... ..... ..
MF,aTB MVv AAY LOCAWr
IUDSV -M MAI11TAW KW'D
t.
r
00 3ph1t.1�
l 111 'v, r
�l 1
' I
�K PA �15101�
�I �I
it 11' �r
s�
TO
i
Intel
5/ape 114
per Ft.
II
PLAN VIEW
11 'r 11
m /ocorinn 07k$ e
�nr� /e cover max.
mib. dim at 20
I pf3L gX
r I m /e>-.
'I • Ye, pNf
�t& Uw cou/Red j V)t
F&ST OE(l sanitary tee
44
g` �r41 0l in et
2 above. my d ou/k
lrputd /eve/ m
i
o
9
out
ca
to
3 min. bed cf_� <"•:'; €;.'FF�';'
� i peogrovP' -
Size shown rs for a ICU09a/ tanA, If a 1252
1 tank use the drm_n>at are show parenthetico
i
#��AN
SGA►� 111= 2a'
f;, Pz = AFMX, WC, MK(, TEST ; KATE ' 24 MIN/
tApWa= APMX I.Or • P*W ZEST Df�GRIP. p l�" To
G
SECTION VIEW
TYPICAL CONCRETE SEPTIC TA
not i0
Putnam County
Division of Envir.
Approved ns noted
apnl.icabie Pulls
FtAnarij County ;ea:
ignature &Title
SEPTIC
F
poi 21 FA
FM# 2 I i
Je�
Tow
PUTT,
Dote:
T. M/
Nr
P0. BOX 243 S
I
16' X 4u' uni ii wIi ,cu .. ,
T_
AfFInMENT OF HEA%T14
4 G'
r- __.._....__..
1
First Fioor — _
Si nature iitl�e Date .
1
'I KITCHEN
' n Ol HIt1G ROOK �li'•L'X 1D'-c'
i I I
27.8"
I •
r1_
----7
�r LIVIRG ROOM
MASTER SEOROOF4
X IS' -c' ;•�
4. 0'
STANDARD NEWFOUNDLAND ND FEATURES
Master
• Luxurious First Floor Suite
Fireplace Options Available
compartmentalized First Floor Bath with "or an Authorized Westchester Builder
• p for a Complete List of Options
Two Separate Vanities
Formal Entry Foyer ° f'.rJst s renderin,s and Flog Plan DirPnsions are
• approxinna:e. b soecilca ions Host tr_ Wriren in Jr_
• Formal Dining Room conuacc No oral conditions.
• Formal Living Room
• Spacious Eat -in Kitchen
s: E R roDULAR OMES, INC.
' Y 12594
l
Reagan
s Mill Road • � ngdafe, N
':r= (914) 832 -9400 0 (800) 832 -3888
IN j
LAURENT ENGINEERING
ASSOCIATES. P.C.
+
MILLBROOKE OFFICE CENTRE
Ro$Ae 22 d MiIRown Road
'
Brewster, New York 10`.+09
\
(914)278-8108 . (FAX) 278.2858
N
60NS6 -TING SITE ENGINEERS
Date: .��GJ ° ��
To:
f iam
Attention:
Gentlemen: We enclose
• B/W Prints
• Specifications
copies of:
O Reproducibles
O Memorandum
,4c1701i,M
Project:
'LO /F5—
O Reports O Tracings
O Copy of Letter O
Description: Revision /Date No.
2�
Sent Via:
• Our Messenger
• Your Messenger
Copy to:
O Blueorinfer
O Hand Delivery
O First Class Moil
O
t
O Special Delivery
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
1
Per: y/ z
. .... .....
00.
/ el
I
—,0 ( 0
rN
r-A
0
ri
n 1 0 m ox
. 0' foj
0 p 0 8
it-
c+ ll�
1-1 0 1:
0 c!,
2
JtA
p T,
n 1 0 m ox
. 0' foj
0 p 0 8
it-
c+ ll�
1-1 0 1:
0 c!,
2
b,4 N E
'_00 • °45 X32 � '' �
0
goo
BC> w
{
NOTE —�
/RED EROS /ON CpNTR01
INSTAL L EO AND APPROVE)
p TO ANY CONSTRUCT /O,
9oOSE0
'EDROO/y
SiOENCE
e 1. 6B5 00
P 0E9R06
5
ot
2 — SDR -35
pR EQUAL �v
a ✓;
6o t./ �S,fa ?Pr /aN pY -L
C.trri�
� (yPANS /ON � Ed -i
guFFER
WETLAND
k
F /
660 rA/OOo V /TY ALLOLNED !N/
N.02' 80.O� E WETLAND BUFFER AREA W.
I REQUIRED PERM/rs.
, . 3) :Y i -4, d
County-
jivision of Envirr
M-
r'
gi Rev. 3/ 6 PLTTAIAAQ•COUNTY -DEPARTMENT OF HEALTH
Division of Envhtinntental Health Se=vlces, Carmel, Pl,7f 10512, ^
- gSnglneer IVfnat Provide (/`�
P.C.H D Permii.i _
'ERTTE F. NS1RUCTWK COWT.IANCETOR SEWAGI- DISPOSAL SYSTRA.,
Town or: Village
Located. at V `� �.�i c c L_cr+•-i a Ta:`MaP dB�ock Lot 3 Z
t� C f tarp• lvr,,djo}
Owner/ licaat Blame f7, t-o m. Formed � � � Sabdh isioa Plane � Sn V. Lot #
�P. �- h Y�tNn i 5 � u.� y
Malling. Address . /'c d .S ( C eo+e. p Date Permit Issued -
Sepaiate Sewerage System built by C �'
_ Andres®
Consisting of
Gallon Tangy and t'n(/l� Oh .`
Water Supply: Fabllc Supply From Address
! R` , A t Addr ti
or. Petvate Supply Drilled by t re
Balldtog TypeTe� `1l �t-; -�. Eeosloa Castro! Been CompletedY Y -�
Number of Bedrooms Has Garbage_ Grfnd,ei Been Installed?
Other, Requirements
i certify that the systeic(s).'as. listed sewing -the above premises were cone ra ted, essentially as.,shown oh plan of the completed work (copies
"of which are attached):, and - in,accordance with-.the.. .standards, riles and re 1 ions; in- accordin• - .with'717 and the permit issued by the
Putnam county DepaztmentL�Of /Health. - / -
' Oats q ' `' �L C ti4led by RE. � RA.
Address W.11 Licence No.
Any .person' occupying prenmis®s served by the above,system(s) shall promptly "ke suewiifion'a6 may be.neeas6ry to secure the correction o9 any - unsanitary
conditions, resulting from usage A'pprovai;pf the separate ierage system shall become null end void a$ soon a$ a pub,': sanitary sswe_ ,pecoMes
v_, _ .
avallabi® and the approval o4 the: private water supply shall become null and eioith ww+�°p�u�, supply' b®Ct)m®i available Such a0p►ovsls are
,'Subject to modification or, chance. when An the _judgment: of the Commissioner .of, H errtii�eQlfieatfonror ehanga is necasis►y. ,
��
,•+;.late 8 Title
i �
NORTH AMERICAN
_. 1AB.ORATORIES,, WC,___
CERTIFICATE OF LABORATORY ANALYSIS
LAB ID NUMBER: 96 -5763
CLIENT: P F Beal & Sons
4 Putnam Ave
Brewster NY 10509
SAMPLING LOCATION: Pyramid, Lot #18, Jennifer l.,n, Carmel
COLLECTED BY: M T B
DATE COLLECTED: 08/23/96 TIME COLLECTED: 7:00 AM
DATE RECEIVED: 08/23/96
DATE OF REPORT: 08/26/96
ANALYTE
RESULT* UNITS
MAX CNTMT LEVEL "
METHOD
ANALYZED
Total Coliform
E. Coli
Absent
Absent
Must be, "Absent"
Must tx "Absent"
SM18(9223)
SM18(9223)
08/23/%
OB/23/%
This sample, as..submitted to .the laboratory, and as compared to the New York State limits for drinking
water-qualityfor dhe tesis performed, was:
ACCEPTABLE. _ NOT ACCEPTABLE.
., h Maw
Maryann Fasano, Assistant 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).
i18 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 -278 -7600 / Fax 914- 278 -7754 / E -mail: NoAmLabs ®aol.com
: 1-Vi2:r I f =71Y DEPA�M/M�rL' Or M LTH
DIVISION Oi ENV7R0N,?- NI- L REPLLTH S 2V-T
CES
O,aner or purchaser
of Wilding
. 1
Building ted by
T ccat].on -- strc- .t
A•'
JJJ
t'Suluci- r��
Building �fr�
P- 3- I
33; Z..�_
Section 3?_�'< c•
r f 121;
SUblvlsioa tU IiL TTT f
SUL- division Lot
C- U ?-Z.= ti11TIZE G' SLT_cUPFP.CV St,1L- E D1SGCS.IL SX.STr,•1
I rcDresent that . i_ am, wholly and ca.,,Dletely responsible. for the lcc<.Lion,
4X�r }T %_Cl5(]1D, M teria 1, cons't -Lice ion and drainage O.L
zr tl ?e sewage Q]_s✓�sal systE;i
serving L. e above des;x�� proceruy, a�:d. that it has -i�z.n co:nstruc-t-c-z as shc. ;n� o:j
the aIDDroved DIaft or approved a-,nendT;ent thereto, and'in - accordance with - -he
st2nd'ards, rules and regulations of th.e :putna't COUnty L%p'Yt-re-nt of EeaI'ch, -.
,haralby Gl—c'?te•v t0 Elie C',,Pez' ", his Successors, heirs or assigns, to place in GCt'.
Operating Condition any i�'_rt OI: said sYste_i construe- ed by me which ia]_!_s ;_o
o_p:ate for a period of 1�4-o yea -..rs - �::3iately 'Col-laying the date of ap roval of. t le
Certi ficate Of Construction Compliance" for the sewage (aspoa?l systpam, o_:
re d?Cs :-ic.Ge b .IC,` "t0 S-UC-1l-sYstail, G:CeDt Y ;here tie ia11UrC' jl5b-` O[fC`2.te is
cause -.L by Lil c or I ?ealige.n.t act- O- the- cccurant.o the bui— ding ULJ_.1.'.'.:::.
SVS*
The u" der_s! fined fllr tiler agrees to accept as conclusive the CetEr✓U]S �.'.c::', c =._
t!ie Dir_ecLo;: OL Div ,i s?_on of T�.'7`. %LrO?i: 1 ?t^_�_ L e. ? -lthl Sal7vioas of the Putnc'_. -,I
Der_ar.t.:n:ent Oil I ealth as to Or not the failure Of the sysiG -r'l to OD Lei'.•.:: S'
caused by the willE ll Or ne-CJl:carit- act Of the occur - nt of the building
the SXStG
Date -1 this 6 cay o� sr��n 19`�(,�
cam:: cC oI:
(:... C.D-' )
Sic na tU Y
Ti'Lle
i.
�_I e<s
RANDOLPH W. LAURENT, P.E
HARRY W. NICHOLS JR., P.E.
September 11, 1996
Mr. William Hedges
Putnam County Health Dept.
4 Geneva Road
Brewster, NY 10509
RE: As -Built SSDS
Lot #18
Jennifer Lane
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
LAURENT ENGINEERING
ASSOCIATES, P.C.
MIL LBRCOKE OFFICE !?E!�!TPE- - - - -•—
Route 22 & Milltown Road
Brewster, New York 10509
(914)278 -6108 - (FA)O 278 -2658
CONSULTING SITE ENGINEERS
1. Four (4) prints of Drawing S -18, "As -Built Plan -Lot 18 ", dated 8- 30 -96.
2. Certificate of Construction Compliance for Sewage Disposal System ", dated 9- 10 -96.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 9- 10 -96.
4. Well Completion and Well Log Report.
5. Water Analysis Report.
6. Money order in the amont of $200.00, payable to Putnam County Health Dept.
If there are any questions concerning the enclosed, please call.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nicho Jr., P.E.
HWN:bd
95011 -18
cc: Mr. J. Mirra w /enc.
WELL GUMYLETlULN �cZrUml
DEPARTMENT OF H`uAALTH
Division Of Env-�rarimertal Reaith :services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREiii ADDRESS: WNI t TAX GRID NUMBER:
Jennifer Lane, Lot #18, Carmel, NY j 3 _ '— 2
WELL OWNER
NAME: ADDRESS: p 0 BOX 555
Pyramid Custom Home Corp. Ridgefield,Ct. 06877
p PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
aRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
❑ BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify)
O INDUSTRIAL 0 INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[-]REPLACE EXISTING SUPPLY TEST /OBSERVATION ®ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 185 ft.
STATIC WATER LEVEL 30 ft.
I DATE MEASURED 8/21/96
DRILLING
EQUIPMENT
Z ROTARY ® COMPRESSED AIR PERCUSSION O DUG
O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING 19 OPEN HOLE IN BEDROCK O OTHER
CASING
DETAILS
TOTAL LENGTH _m.2—_ ft
MATERIALS: ® STEEL ❑ PLASTIC O OTHER
LENGTH BELOW GRADE 42 ft.
JOINTS: O WELDED ® THREADED ❑ OTHER
DIAMETER 6 in.
SEAL: [2CEMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT PER FOOT t Ib. /ft.
I DRIVE SHOE O YES ONO
I LINER: O YES E NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TU SCREEN (it)
DEVELOPED?
FIRST
❑ YES ONO
HOURS
SECOND
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH ft.
BOTTOM
DEPTH ft.
WELL YIELD TEST It detailed pumping
METHOD: O PUMPED t tests were done is in-
• COMPRESSED AIR ; 'Ormation attached?
❑ BAILED ❑OTHER ❑YES ❑ NO
WELL LOG If more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE.
g a1rr
ina
Well
Did-
neter
FORMATION DESCRIPTION
coat
ft.
I ft
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIEt.D
gpm.
Surface
25
Dr
L 1 ling
in overburden clay & boulc
er
25
Hit
rock
at 25'
185
6 hr
140
5.5
25
43
Dr
ll-.ncf
in rock,set casing, grout Ed
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? ❑ YES O NO
STORAGE TANK: TYPE
CAPACITY GAL
PUMP INFORMATION
TYPE s ubme r s i b l eCAPACITY
MAKER Goulds DEPTH i 6n,
MODEL 7G S 0 5 412 VOLTAGE �0 HP .�..,C2
WELL DRILLER NAME P. F. Beal & S s I DATE / 10/96
ADDRESS 4 Putnam Ave. SIGN
NY 10509
Brewster, .
3[n t% Malcolm T. Bear, Jr.
7
S'.
7�
;t
t
.i
0
1
V
K
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
WELL OWNER
.Street Address
Name r
Town Village/ City Tax Grid Number
Mailing Address OPrivate
�(c8 A; g � qJ O Public
SE OF WELL
- primary
2- secondary
``��
FI RESIDENTIAL
D BUSINESS
13 INDUSTRIAL
[]PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
b INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT
`� gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 6poO8a1
`'REASON FOR
0 EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY
DRILLING
_FPLACE
94EW S PLY
DWELLING ) O DEEPEN EXISTING WELL _
!DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN []DUG GRAVEL
0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES z--NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. ?�
WATER WELL CONTRACTOR: Name d -4 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES "0
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
- ,- "bISTANCE- TO. PROPERTY_ FROM NEAREST WATER MAIN:" _y _: _ _, -_ __ _ _.. .
LOCATIO S ETCH & SOURCES OF CONTAMINATION PROVIDED
SEPARATE SHEET
2--L - - - ( �. Ae�
(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 shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
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: 19
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
y• , b
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_ .. _.._ .. .
Date
Re: Property of ANC/C 102,09L7A
Located at rP1P- ®/t 4S
(T) Section Block Lot
Subdivision of
Subdv. Lot # �t Filed Map # °��- Date 12,12 (W'6
T. WHCHAEL DALE', P.E.
CONSULTING MIMI-
Gentlemen : P. 0. BOX 243
This letter is to authorize SHE1VOROCK, N. Y. 10557
a duly licensed professional engineer 41__� or registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned
P.E., R.A., 0
Very truly yours,
f. MCHAEL DALY, P.E.
Address 1
P,,. 0. BOX 243
SHENOROCX, N. Y. 10587
fined
Owndr of ,PI operty
Address
b1-&.Vx Al
Town
/, 2 - a&.3 3v�
Telephone
Telephone %'
PUTNAM C OUNTY DEPARTMENT O F HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant: AXIQ Ic "A�D
2. Name of Project: Qe�,we� 3. Locatio & /C:A"t'tt�'j"Q.l
4, Project Engineer: ?o=- 5. Address: -'&eX 24'-3
CJj� -.O ?per UJ
License Number • Phone •
6. Type f Project:
ri vats/Res i dent ial Food Service Commercial
Apartments Institutional Mobile Homd Park
Office Building Realty Subdivision Other (specify)
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? .............
9. Has DEIS been completed and found acceptable by Lead Agency? ........... `
0. Name of Lead Agency
1. Is this project in an area under the control of local planning, zoning, .,x..
- or_..ot.her of_ f.
. -..•_• •_... •_..• • • ...• •_•. •. •_.ate_•_• • •.,.•.• • •.•.• •�•. •.. ..�.�-
2. If so, have plans been submitted to such authorities? ..................
3. Has preliminary approval been granted by such authorities? Date Granted:
1. Type of Sewage Disposal System Discharge.�Y5'1Surface Water Ground Waters_.,
i. If surface water discharge, what is the stream class designation ?........
i. Waters index number (surface) ........... ...............................
Is project located near a public water supply system? ..................
If yes, name of water supply Distance to water supply
. Is project site near a public sewage collection or disposal system'.....
• Name of sewage system Distance to sewage system
• Date observed: 23. Name of Health Inspector: t
• Project design flow (gallons per day) ...................... &Q�)........
Zs.
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?..
.26. Has SPDES"Application been submitted to local DEC Office? ...............
27. Is any portion of this project located within a designated Town or State
wetland? ......................... i ........................................
28. Wetland ID Number .......................................................
29. Is Wetland Permit required? .................. .......
Has application been made to Town or.Local DEC Off1ce? ..................
30. Does project require a DEC Stream Disturbance Permit? ...................
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
l,andfilling, sludge application or industrial activity? ....... YES or NO'
32. Is project located within 1,000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source-of contamination? ...............YES or NO
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?
35. Are any sewage disposal areas'..in.-excess of 15% slope? ..................
TaxMap ID Number .................................... .................
37. Approved Plans are to be returned to: ................ _ Applicant engineer
If the application is signed by a person other than the applicant shown in Item 1, the
application must be accompanied by a Letter of Authorization. Failure to comply -with this'
provision may be grounds for the rejection of any submission.
J hereby affirm, under penalty of perjury, that Information provided on this
form Is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuanA to Section 210.45 of
the Penal Law.
SIGNATURES & OFFICIAL TITLES: ,4d �_L
\7
MAILING ADDRESS:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING; CARMEL, N. Y. 10512
DESIGNJ�DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM
MA FILE NO.
Address -Z 600 'g—:r -'-D�.'PTq'`1 -i � 'Q,G
Located at (Street t TgE 1 p se : , Block _Lot
6dicate nearest cross s ree
Municipality. Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
Depth
to Water
Water Level
No. Time
From Ground Surface
in Inches
Soil Rate
"Start -Stop Min.
Start
Stop
Drop in--
Min. /in drop
Inches
Inches
Inches
1 1 t03 t 110k 3o
ZI
712 z
� 2
Zv
2 (lot c 31 ZI z ui-
3 lC3 t Izo t 30 Z( Zz (4- 1 T Z
4
5
Z 1 i e 3 z- I I Oz Z Z (� �q, 3
3 031 1202 � Z/ - 1 314 ; IA- Z-W-�
4
5
1
2
3
4--
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.' 1 HOLE NO Z HOLE.NO'.
G.L. ! ate` �c� ?'En u-
6" f
12
18"
24 It
3011
36"
42"
48"
5'"
60"
66"
72"
7?J If
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES.AFTER BEING ENCOUNTEREA
TES•TS 1�OE''BY _ � - _�..... _.
Dste k 1 kOlp - -- --
D I N
Soil Rate Used�Min/1 "Drop: S.D. Usable Area Provided _
No. of BedroomsSeptic Tank Capacity Gals.
Absorption Area Prov ded By_6QO L.F.x24
_ _ „ . _ , n ni&iature
Address
SEALi`=,
THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY:
.._.......
_. . _. . .- -. Date_
Soil Rate Approved Sq.. Ft /Gal. Checked by
,4 � �---r �� ..
.: -