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Home My WebLink About1412DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 33. -2 -34 BOX 13 01412 IL ��.' ti ,In r , . on �0 � '�T 1 ; �1 N.wl loin 16 6. .- UL 01412 COMMIStI119 of Gallon S4t1c Tank and. ..dl,. Type Lot Has Erosion Cnntrnl. Been rqjnp 1 el- ed 7 Number ef Bedrooms �'Iiis Garba& grinder Eieen Installed? I certify that the-systam(s) as listed serving the above prizises were constructed essentially as show . n on the plans of the completed work copies pla nd Ithe permit issued by the Putnam County Department 0 lth.. Addr. No. Any person occupying premlos servied by the �IbOve system ' (S) Mall promptly take such action as maybe necessary to secure the correction of any unsanitary conditions resulting. from Such, uselIC Aiiwo4al of 1110 .Separate sewiragi'systiM Shalf become null and void as soon as a "t!: unitary �� we am Shall 64C6 '0 Mli and void when a ' tic �vater suiply'bicomas swells available and the approvill di the 014itiwatii Supply puli ble. Such approvals we subjict f� modification �4an. in the. Judgment of the Commismo tion, modification or change Is necessery. Date ~ TRW >:� i InA1nr;9iMlnri.Aln./rir ni.ni. wr..r..�..�...__._ _ ...... ........ .. �3 NORTH AMERICAN LABORATORIESe INC. Ivari21 LAB ID NUMBER: LABORATORY REPORT PW 95 -2932 CLIENT: I' F Beal & Sons 4 Putnam Ave Brewster NY 10509 SAMPLING LOCATION: Pyramid Const., Lot 15, Jennifer Ln, Carmel NY COLLECTED BY: P. Beal DATE COLLECTED: 06/13/95 TIME COLLECTED: 9:00 AM DATE RECEIVED: 06/13/95 DATE OF REPORT: 06/16/95 ANALYTE RESULT UNITS METHOD ANALYZED Total. Coliform Absent Colilert 06 /13/95 E. Coli a__. .Absent... ._ __ Co -h1jrt 06%13795 - -- 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: 8% ACCEPTABLE. NOT ACCEPTABLE. Laboratory Director NYSDOH ELAP #11218 CT Lab Approval #PH -0171 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914 -278 -7600 / Fax 914- 297 -0536 WELL GUM.FLETIUN KEtrUKi * * DEPARTMENT OF HEALTH - Division Of- EAVironiuentai Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TDWNIVIL101111CRY TAX GRID NUMBER: Lot #15, Jennifer Lane, Carmel, New York WELL OWNER NAME: ADDRESS. BOX 451 Pyramid Custom Home Corp. Crompond, NY 10517 O PBIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary 9 RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 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 325 ft. STATIC WATER LEVEL 30 ft. I DATE MEASURED 4/7/95 DRILLING EQUIPMENT 9 ROTARY ID COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 52 — tL MATERIALS: 125 STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 51 ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 lb./ft. I DRIVE SHOE 0 YES ❑ NO I LINER: G YES ® NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (it) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH h. WELL YIELD TEST If detailed pumping METHOD: O PUMPED tests were done is in- COMPRESSED AIR , ! ormation attached? O BAILED O OTHER ; ❑YES D NO I�I�LL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE. Water Bear- I„q well Dia- meter FORMATION DESCRIPTION q0E it tt WELL DEPTH it. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface 37 Dr' lli cr in overburden clay & boulders 37 Hi r k at 37' 325 6 260 6% 37 52 Drilli in rock, set casing, grout ad 52 325 Dr lli g in rock granite WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑YES ONO STORAGE TANK: TYPE Well Xtrol WX #250 CAPACITY GAT,. 44 PUMP INFORMATION TYPE submersible CAPACITY 7cfpm MAKER Goulds DEPTH 280 MODEL 7EH07412 VOLTAGE 2341Ps WELL°RILLERNAME P.F. Beal & Sons, Inc. °ATE6 95 ADDRESS 4 Putnam Avenue SIGNATURE // Brewster, NY 10509 'f7 37$9— 4 alcolnV T. Beal, Jr. July 12, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: As -Built SSDS Lot #15 Jennifer Lane Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MIL L.BRQQKE_01WICE CENTRE _ Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)) 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing S -10 "As -Built Plan ", dated 7- 12 -95. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 7- 12 -95. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 6- 30 -95. 4. Well Completion and Well Log Report. 5. Water Analsysi Report. 6. Money order in the amount 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. VQ Randolph W. Laurent, P.E. RWL:bd 95011 cc: Mr. J. Mirra w /enc. PUrNPIA COUM DE'_0PR /IaU OF HEALTH DIVISIO N OF EDWIRCVNI � TP.L nE LTH SERVICES 6TV O,aner or Purchaser of ilding Section Block Lot Building nstructed by •• � �NG150.,� Location - Street Sdbdivision i e9 icit l ity Subdivision Lot Building Tye GU a R_k N E_ OF S UESURFACE S &Q�.GE DIS IPO_Q? r, SYSTEM I represent that I an wholly and completely responsible for the location, wor , ship, material, construction and drainage of the. sewage disposal system serving the above de---r--rib,-;-,d property, aDd. that it has -be-en constructed as shown on the approved -plan or approved amend -ment. thereto ,..and*in accordance with the standards, rules and regulations of the :Putna„t County Depax-tirent of Health, and ;hereby guarantee to the ayner, his successors, heirs or assigns, .to place in go6d operating conditioiz any part of said systen constructed by me which fails to operate for a p ricd of two years irrredi.ately following the date of approval of the "Certificate of Construction. Ccooliance" for the sewage disposal system, or any repairs lade by rrn to SL'G7 SyStEi1�- except'- where- the failure to operate proper_)_y.. is caused by the willfu'1 or negligent act of the occupant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the deteaaination of the Director of the Division of Envizor_�, ntal Health Services of the Putnara County Department or Health as to whether or not- the failure of die. system to oDerate was -- used by the willful. or negligent act of the occupant of the building utilizing the system. i Dated this pay o 19q Sicnatur Title C Contractor (Cte �n ) - Signat &r'e Corporation Name (if, Corp.) Corporation Name (if Corp.) .P.ddress /OS rev_ 9 /as mk s DIvMMe PuMMCOUNff lmrrleonrai 6 Samoa. OCan" N Y l0U C an o QO FPe w alai ARM 1101t SEWAG DMOQSAL STU= et u�i'_ wh o _ ar Vubw stilra.lia. NftfBahcisoi^ ?/%/.Cs cabd �iwt %.S a-9 R=@y d O RevhMn 0 Qp Date of Peevbo Apprtlyel ,rang Aslioee ,LAY � ci,Yj%i7 T. a1 Ma, '4Fa .os.aPh, a f Lot Are& 2 DD6 cues Fm Seello 0* Dptb 01- V Vuhloe Humbee et B Deluge Flow G P D PCHD NoWkeden M Regarod Wbee FM M mwle6d SepeaM Sot mV Sjaea. »aeon e[ �1ZC.eiw SepIM Tack --a te . F G6 s . �'r -Pn� Ad&*= Wear S"*. P,- Sop* Fig Aaare.. an. --Pd.af. Sib DrEed by Odw to e 1 reprNant''thet 1, am wholly and completely responsible for the design and location Of the proposed system(s); 1) that the upstate sew di sal system above described Will tar constructed as shown on the approved amendment theta to and in accordance with the standards, rules • ►egu ns o he County -.DWertment` of ;.IMelth. ,and that on completion - thereof a "Certificate of Construction Compliance". satisfactory to the.Commis"nw of Healthwill be wlbmltted to this Depullment, and a written guarantee will be furnished the owner, his succemors. heirs or assigns by the builder, that veld builder will Place 'in pod .operating condltlon . any part o1 uld ' sewaN disposal system during the period of two (2 yews Immediately following thedate of the imu- Once of the approval, of the; Certifkab of Construction Compliance of the original system or any r s thereto; 2) that the drilled well daeribed above will be located es,d— oa the appiov plan and that uld well will be Instal in aeeordanoe ith, the rules and regulations of the ' Putnam County Department of Health, t Date r -. 3 — Signed M. 21 ` license No APPROVED FOR CONSTRUCTION- This approval expires two years from the date issued unless construction of the building has been undertaken and is reiwcaCle for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of Construction "quires a� parmit Approved for disposal of domestic sanitary sewage, and /or private !� �:pply only. Rev -. bate /J Q" r! �Sr�/ :! is By 10/88 , RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROC`KE,OFFICEC.EW- RE.... -. - Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS Date: 4 -17 -95 To: Putnam County Health Dept. Job No. 95011 4 Geneva Road Project:Windsor aks -Lot 15 Brewster, NY 10509 Jennifer an Attention: Mr. William Hedges Patterson, N.Y. Gentlemen: We enclose (1 ) copies of: /\ /\ /\ /\ \ /B /W Prints \ /Reproducibles \ /Reports \ /Tracings /\ /\ /\ /\ \ /Specifications \ /Memorandum \ /Copy of Letter \/ Description: Revision /Date NYSDEC Wetland Permit for proposed well. April 14, 95 For your information i t via: and Delivery \ /First Class Mail \ /Overnight \ /Pick up Copy to: Mr. J. Mirra w /enc. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. hhclt 1 N %� c5 �l� f3) ) Harry W. Nichols, Jr., ".E. 95- 20- 600/901-2tlC R3 DEC PERMIT NUMBER 3 -3724- 00103/00001 -0 FACILITY /PROGRAM NUMBER(s) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION .PERM11- Under the Environmental Conservation Law (ECL) EFFECTIVE DATE I April / '/, 1995 EXPIRATION DATE October 15., 1995 TYPE OF PERMIT (Check All Applicable Boxes) ® New 13 Renewal ❑ Modification ® Permit to Construct ❑ Permit to Operate UArticle 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 15, Title 5: Protection of Water PERMIT ISSUED TO Crom ound Contracting Corp. Article 17, Titles 7, 8: SPDES F-1 Article 15, Title 15: Water Supply PO Box 451, Crom ound, NY 10517 Article 19: Air Pollution Control F-1 Article 15, Title 15: Water Transport Article 23, Title 27: Mined Land Reclamation aArticles Article 15, Title 15: Long Island Wells FX Article 24: Freshwater Wetlands ...... _ ._. ...._....., ., , - TOWN Article Title 27: Wild, Scenic &Recreational Rivers a Article l Tidal Wetlands Patterson 6NYCRR 608: Water Quality Certification E: N:. 4 Article 27, Title 7; 6NYCRR 360: Solid Waste Management Install a well and water proposed UArticle 27, Title 9; 6NYCRR 373: Hazardous Waste Management By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this permit. DEPUTY PERMIT ADMINISTRATOR ADDRESS Alexander F. Ciesluk, Jr. 21 South Putt Corners Rd., New Paltz NY 12561 PrAFC AUTHORIZED N URE Date / 9S� Page 1 of 4 Crompound.pmt (eh) TELEPHONE NUMBER PERMIT ISSUED TO Crom ound Contracting Corp. Article 34: F-1 Coastal Erosion Management PO Box 451, Crom ound, NY 10517 Article.36: F-1 Floodplain Management 1, 3, 17, 19, 27, 37: aArticles 6NYCRR 380: Radiation Control a Other By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this permit. DEPUTY PERMIT ADMINISTRATOR ADDRESS Alexander F. Ciesluk, Jr. 21 South Putt Corners Rd., New Paltz NY 12561 PrAFC AUTHORIZED N URE Date / 9S� Page 1 of 4 Crompound.pmt (eh) TELEPHONE NUMBER PERMIT ISSUED TO Crom ound Contracting Corp. (914) b28 -6906 ADDRESS OF PERMITTEE PO Box 451, Crom ound, NY 10517 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Joseph Muro, President NAME AND ADDRESS OF PROJECT/FACILITY Lot 15, Jennifer Lane LOCATION OF PROJECT /FACILITY Windsor -Oaks Subdivision (former) Fair St. Subdivision) COUNTY ...... _ ._. ...._....., ., , - TOWN WATERCOURSE/WETLAND N0. " "- - NYTM COOK ^utNATES -. Putnam Patterson FW -LC -15 E: N:. 4 DESCRIPTION OF AUTHORIZED ACTIVITY line for: a 3 bedroom residence in accordance with drawing SS -15 dated Install a well and water proposed February 7, 1995 and last revised March 14, 1995 as prepared by Laurent Engineering Associates, P.C. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this permit. DEPUTY PERMIT ADMINISTRATOR ADDRESS Alexander F. Ciesluk, Jr. 21 South Putt Corners Rd., New Paltz NY 12561 PrAFC AUTHORIZED N URE Date / 9S� Page 1 of 4 Crompound.pmt (eh) AML sszoero�e�1 zscro Now York Stots Dspsrtmsnt of Environmontd Conssrvstion qW _ Y GENERAL CONDITIONS Inspections 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of. Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71 -0301 and SAPA 401(3). A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is in violation of this permit. Permit Changes and Renewals 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department for renewal, modification or transfer to this permit. Such application must include any forms, fees or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management. Facilities (SWMF); _and. _ -- b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of, this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights -of- way that may be required for this project. 3 " 3 2.2 V — 00 /0 3 160 oe / — 0 Page 2 of 4 DRAt:PERMITP2 2/94 ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24,25,34,36 AND 6NYCRR PART 608 Freshwater Wetlands 9. That if future operations by the State of New York require an alteration 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 r ...... •obsUvetion_to ..the•free navigation offsaid 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 completed, 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. 10. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 11. Granting of this permit does not relieve the applicant of the responsibility 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. 12. 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- es3ociated with the project: - - - - - - • - 13. 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. 14. There shall be no unreasonable interference with navigation by the work herein authorized. 15. 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. 16. If granted under Article 36, this permit does not signify in any way that the project will be free from flooding. 17. If granted under 6NYCRR Part 608, the NYS Department of Environmental 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 1977 (PL 95 -217) provided that all of the conditions listed herein are met. 18. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. / Such approved plans were prepared by S*+� on SPECIAL CONDITIONS w* The permittee or a representative shall contact by telephone, the Division of Law Enforcement in New Paltz (914) 256 -3013, 48 hours prior to the commencement of any portion of the project authorized herein. " The permittee sh6[r requlre-that any''6or1tJract&',' 0fbjecfengineei�; or other person responsibie for "the ove�air" supervision of this project reads, understands and complies with this permit, including all special conditions to prevent environmental degradation. ♦ For Article 15, Protection of Waters permits,'the permittee or an authorized representative shall notify the Department by mailing the attached form at least 48 hours prior to the commencement of any portion of the project authorized herein. Continued on next page... DEC PERMIT NUMBER 3- 3724 - 00103/00001 -0 PROGRAM /FACILITY NUMBER apage.trm PAGE 3OF4 "- 9MfiF17/871 -25CR3 . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article 24 (Freshwater Wetlands) 1. Work shall be done in accordance with the approved plans. Any modification to these plans that will affect Freshwater Wetland LC -15 or the adjacent 100 foot buffer area must be approved by the Department prior to being undertaken. 2, Within one week after commencement of work authorized by this permit, the Permittee shall notify the Department's Regional Supervising Wildlife Biologist, 21 South Putt Corners Road, New Paltz, NY 12561, in writing that this work has begun. 3. EROSION CONTROL: Prior to commencement of the activities authorized herein, the permittee ;hall irct811 Silt fencing and /or continuous staked hay hales a! --ng the Hmits -of- disturbance as shown on the plans or drawings referenced in this permit, or along the freshwater wetland or adjacent area boundary as delineated by DEC staff and represented on the referenced plans, whichever is farthest from the wetland proper. These erosion control devices shall be maintained (and hay bales periodically replaced) for the duration of the authorized activity to prevent any silt or sediment from entering the freshwater wetland or its adjacent area. They shall remain in place until the disturbed area is fully stabilized with vegetation following which the hay bales and the accumulated silt or sediment shall be completely removed from the site. Removal must be complete prior to the expiration date of this permit. 4. There shall be no cutting of vegetation or clearing of land within the wetland or its adjacent 100 foot area as shown on the approve drawing. except for that work necessary to access the well location and install the water line. 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 established. STATE ENVIRONMENTAL QUALITY. REVIEW Under the State Environmental Quality Review Act (SEAR), the project associated with this permit is classified as an Unlisted Action and the Department of Environmental Conservation (DEC) has determined that it will not have a significant. effect on the environment. Other involved agencies may reach an independent determination of environmental significance for this project. Distribution: Law Enforcement (2) R. Wood R. Stevens DEC PERMIT NUMBER 3- 3724 - 00103/00001 -0 FACILITY ID NUMBER PROGRAM NUMBER Page 4 of 4 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 7 2. Name of Project: 1��'UPDGJ�1� ��DS 3.._,_Location T/V /C: 4. Project Engineer:. � � �) IJIGHOJ.s T,T - 5. Address: M11�I,t�i 0D 0f tG Gtr -N"j l.` IN 4 WL4, PWO row 0 Y 1050 License Number: ��0'12 Phone: 6. Type of .Project: ✓ Private /Residential Food-Service ...Commercial , Apartments Institutional Mobile Home Park Office Building. Realty Subdivision. Other (specify) 7. Is this project subject'to State Environmental-Quality Review (SEQR)? ly Status (Check One) Type I.. Exempt ✓ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ..............° tJ U 9: Has .DEIS' been 'completed-- and.;,found acceptable by Lead Agency? .... .... rJ�A 0, Name of Lead Agency :1. Is.this project in an area under the control of•localfplanning, zoning, ... ___:o.r...other...offscia -ls,. ord�nanees ?__.._....•..- ...._.._.. ". " -_._ ;::.... .........:..... ..:._. 2.1 If so, have plans been _submitted to such. author .s tie s ?.. ................... 3--Has preliminary approval been granted by such authorities? 0A Date Granted: 4. Type of Sewage Disposal: System Discharge...... Surface Water v Ground Waters 5. If surface water discharge, what is the stream class designation ?.....:.. OZA �. Waters index number (surface) ............ ................:.............. 0141, Is project located near a public water supply system? .................. D If yes, name of water supply 4.l /AA Distance to "water supply , Is project site near a public sewage collection or disposal system ?..... IJo Name of sewage system WA Distance to sewage system Date observed: 23. Name of Health Inspector: Project design flow (gallons per day) ..................................... 600 25. Is State Pollutant Discharge Elimination "System ( SPDES) Permit required? tJo 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland ? .................... 28. Wetland ID.Number ......................... ............................... 0 29.-Is Wetland Perm, it. • required?* .............. ............................... _gin Has-app lication been made to Town or -Local DEC.Office? 30. Does project require a DEC Stream Disturbance Permit? tJ 0 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 NO K)o 32. Is project located-within 1;000-feet of existence.of abandoned landfill, -hazardous waste site; salt stockpile, landfill, sludge.di.-sposal site-or- any other potential known-source of contamigation ? :..............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? UN KN)Ao� 35. Are any sexage _d s.posal ,areas . in excess .of. 1.5-_ slope? , . ,.. �.,.._��.._,_•.- - ��7._:.. . 36. Tax Hap, ID Number ........ .. . ............... 3� —�' 9_ 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 t S provision maybe grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that. information provided on this form is true to the best of my knok7ed5e' and be 1 ief. False statements made herein are punishable as a Class A Hisdeareanor p rsuant to Section 210.45 of the Penal Law. Al / /- i 31GNATURES & OFFICIAL TITLES: MAILING ADDRESS: - PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - - DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SAEET- SUBSUFACE SEWAGE DISPOSAL.-SYSTEM. _: FILE..NO. Owner C�,T Address V Y /G' S/ Z Located at (Street)- l ei�H,`� rG�e,�� Sec. ,33 Block -�Z Lot 3y . (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test HOLE. NUN= CLOCK TIME PERCOLATION PERCOLATION " Run Elapse Depth to Water From Water.Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 3 31,1 4 5 1 // 3sf - /;� -off : s'd 23 '' - % ?ly % — 2 3 3o a3 /.' 23 y� p 4 5 1 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 suhmitted for review. 2. Depth measurements to be made frcm top of hole. rev. 9/85 mk TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. �_ HOLE NO. 02 HOLE NO. 2' 31 Loan, Goaw 4' GjYti�l 51 6' 7' 8' 9' 10' 11' - 12' 13'. 14' - INDICATE 'LEV''' r AT WENCH GROUNDWATER- IS ENCOUNTERED - - INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 3/- ys Min /1" Drop: ' S: D. Usable Area Provided No. of Bedroans Septic'Tank Capacity Ipoa gals: Type Absorption Area Provided By �yO L.F. x 24" width trench Other 2,`�- Name G-avr� f!` �r�,�, ee, so�� c�2s AC. Signature 1 r Address /tl, ��tk1�/ ,��P SEAL DD / //JJ 3 2a f �i��ibwa /'1� 1�rP�✓,s /ley /aSo9 ~F� No. 5v�2a� 1 �* THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION -TO_- CONSTRUCT A,WATER WELL 9 PCHD PERMIT y/ WELL LOCATION Street Address Wh Village City Tax Grid Number /71617_s,ol _J511 WELL OWNER Name Mailing Address f-050,< Gvdn, &Private 0 Public USE OF WELL ®- primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL O INSTITUTIONAL Q AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY Q ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED±- /EST. OF DAILY USAGE_,�IS6 gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION G ADDITIONAL SUPPLY -NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING � WELL TYPE DRILLED ODRIVEN DDUG []GRAVED 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L'/hA,� aks: Lot No. (S WATER WELL CONTRACTOR: Name i<u) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET ~ 0,9 gnature) (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of_Part 5 of the New York State Sanitary Code, and provided that within 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 surface or groundwater. Date of Issue: 19 l 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 PUTNAM .COUNTY DEPARTDiENT OF HEALTH DIVISION OF ENVIRMIENTAL HEALTH SERVICES _ Date. Re: Property of•'%G�,,� Located at `) 2yjg (T) �(�y Section 33 Block �2 Lot Subdivision of Z. car lla%c _ Subdv. Lo : /T riled Aian 1 aent1emen: This letter i s to authorize u,-_ ia��s V �. Date ..a duly licensed:professicnal engineer X or registered architect 0; (Indicate) i to. apply for a Construction Permit for a separate •set, *age system, to serve the above .noted property in accordance with tine standards, rules. or regulations..as oromulaga ted by the Commissioner of. the Putnam County Department of lHealtn', and t:o' sigri, a1-1 .necessary papers on my :behalf. i.n- connection ZYith this mat" ter and to supervise the construction of said .. . -, a system. or sys ems n conforrii ty' iiith the provisions �of :4rticle 11� j' bx " t - 147, Education La.a�,- the •Public Health Lai.,; and the Putnam County Sari.- ;:... ;; -.`.. - tary Code Very truly yours, ?k E 1� Signed Gam, ✓!/L� _ 'ner of Property Countersigne �'OFEt�S10�`� ` J ra L4.. L j ' Cus �.- P.E. , R.A. , :address Millbrooke Office Centre Ra4J l.ro 165/7 Address Toti.-n Brewster, NY 10509 Telephone 914- 278 -6108 Telephone cC Firs[ Floor C; ;� :. ; t' DINING ROOH c KITCHEN t ) 14ASTER BED, -ROOa X I3'- O' .. 1. .'X IS' -0' Rio I M LlYltti6 ROOH Is'- 0'X15' -0' STANDARD NEWFOUNDLAND FEATURES • Luxurious First Floor Master Suite • Fireplace Op[ions Available • Compartmentalized First Floor Bath with • Consult an Authorized V'lestchester Builder Tv ✓o separate Vanities for a Complete List of Options • Formal Entry Foyer • r. <-t's renderings and Flog ?'an Dimensior,s are a,ProrJr..a :e. /%il SG< :ik2Lio ^s nest^ �Jri— :en in Lhe • Formal Dining Room Contract No oral co di:jons. • Formal Living Room • Spacious Eat -in Kitchen ESTCHESTER ODULAR OMES, INC. Reagan 's Mill Road • Wingdale, NY 12594 '``'� (914) 832 -9400 • (800) 832 -3888 27'8" V. 1 STANDARD NEWFOUNDLAND FEATURES • Luxurious First Floor Master Suite • Fireplace Op[ions Available • Compartmentalized First Floor Bath with • Consult an Authorized V'lestchester Builder Tv ✓o separate Vanities for a Complete List of Options • Formal Entry Foyer • r. <-t's renderings and Flog ?'an Dimensior,s are a,ProrJr..a :e. /%il SG< :ik2Lio ^s nest^ �Jri— :en in Lhe • Formal Dining Room Contract No oral co di:jons. • Formal Living Room • Spacious Eat -in Kitchen ESTCHESTER ODULAR OMES, INC. Reagan 's Mill Road • Wingdale, NY 12594 '``'� (914) 832 -9400 • (800) 832 -3888 Rirnam 1 -unty F}epartment of Health Divisior; .f Environmental Sanitation AFFIDAVIT - CORPORATE 9,;NIER APPLICATION FOR PRRMIT.APPLICAT -10N. SUBMT_TTED• TO PUTNAM COUNTY HEALTH DEPARTMENT T0: Commissioner of Health - In the matter of application for Ni9-2r't '_ _ _ _ _ ._ ._ .: represent. that .1 am an officer or employee of the corporation an am: authorized ' to act for• P'f!- riiGC_�i �y" (name of corpoZfition� J `� having offices at _MIP(�^ reoh'JPo/v� ^� /v�' Whose officers -are President ^�cSe� /� _m1le -g-ig 3q �i%/t �Lr£ w C,QG��'�y9 ✓�.�% (�1ame and Address) Vice - President —� ^ -- (Name and Address.) (Nam and Address)— - Tr easurer' _ _ _£_ _ _ _ - — — — (Name and Address)— r — _ - and that I- am-and will be individually responsible fon any* or all aptp� Of* , the- corporation with respect to the approval requested and -all .sub - seque`nt acts relating - thereto. S.;orrr to before ine, this day Signed o i EC'�J /J�� 19 Title Notary Rb ic' BONNE J. D r` S 1 r� lr� CGi�I�iv��J a L'•i,f1�lJ ��. �C, �_ • I Corporcte Seal I J -05 1 -lax 3. rat it w " �M�Ng ;� APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION''OE' ENVIRONMENTAL "HEALTH" SERVICES" INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SIi ET . fo MIT STREET LOCATION A� ME OF OWNER ' BY B. HEDGU�a R.MORRIS OTHER DATE i X �LAP T DOCUMENTS.. kYN ✓ YIY fTT APPLICATION EXP. AREA; SHOWN: GRAVITY FLOW, SL'FF.SIZE DETAILED EL T W PWS LET i LR' G tiEERS AUTHORIZATION DATA SHEET(DDS) -:`7 - - - '' CO TE RESOLL-iION THREE SETS ' OU aNS - TWO SETS ARLANCE REQUEST PL. IPED &: D BOX SHO�i N O 'S NO. OF BEDRGO�IS W L & SSDS'S WAN 300 FT. OF PROPOSED SYSTE.1 P :METES &= B0U-,tiDS OUSE-SETBACK NECESSARY (TIGHT LOT) USE SEWER - U-I"/FT. 4'0; TYPE PIPE NO BENDS: `L-kX. BENDS -15 W /CLEAN' 0 C FILL SYSTEMS JE/VN FER LA AIE \�\ .••/Y /5'06 -'O8 "E X W I � Q L 8 9• /3 A 3 BEOROOiy RES /OENCE WOoD OECK C Ty i-�'000/ N 1 C. /. P. v /� sAL. SEPT /C TANS J =14 tb i o, IY I 1`` {jam IY I II ZI SITE L Sc FROPEIUY TAX MAP ou'"nam oeunt "lvieiony of Envir APproved as noted ;PPlicable Rules s 'utnam Count `1onmture a Tit1R . AS - BUILT D l MIZNSION CYART f IIV Fr) �o A B / 56 2 33 �O 3 39i 9� S X5.5 5g 6 57 7 65 9 Qo 65 995 �9 5 l2 55 V..5 13 61 5 98 /g 7'f 32 16 775 �1.§ ly Of /8 07 5�S /17 9/ 6/.