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HomeMy WebLinkAbout1467DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -1.2 BOX 14 L Jr Ir i 01467 - AALL On" of Previous Approval 1, SOW—W SY@k- se; oundist of 1169-0—Gallon Seplic Tank and r_ AO -C-1 _T9 TO be retakes m Aed by— Toy Address- Wasir Suppor.—Palwile Supply F—. Address I represent that, I am wholly and completely ril"nsibi efo I r the design and iocat ion of the proposed Systern(S); 1) t hat the separate saw&" disposal system above described will be constructed as shown on the approved amendment there to and in accordance wl . th the standards rules and regulations of the PRISM County Department of. Halth, and that on completion thereof a-C"ficate of construction Compliance" utistactory to the Commissioner of Multhwill guarantee will be urn is". the owner. his su "ors, hel's or signs by the b face in good operating condition any -part of said sawage disposal system, during toirj%-rR 11 t�' 12) yearsairnmediately following the date of the Issu- 4 oln=irs thwato; 2) that the. drilled well described above once of the'appri6val'of the Certificate of construction Compliance i, st syst will, be1aiiied as'shaswn an the approved plan and that aid well will be In led I r ith rules and regulMns of the Putnam County Department of Healith. Dot igned P.E. -'` -`- -` --'' —``- `--------' `-` -----` ~ APPROVED FOR CONSTRUCTION' This Approval revocable for cause 4ir'rhaV tie amended orm,odified Rev. rectuir" a ne� permit. Approved. for disposal, of M] License No 4 expire$ two y rs f m the d I 'Wed les construction of the buildinghas been undertaken and is 'when consid ry by, I, rninIssioner of Health. Any change of alteration of constructkm *1 . .. I By Title --------' --------'----- -------'------- - 1 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Randy Laurent Tel (914) 278-6130 Fax (914) 278 - 7921 Tammanv Hall Road Patterson, New York 1263 Dear Mr. Laurent: le BRUCE R. FOLEY Acting Public Health Director October 15, 1997 Re: Proposed SSDS: Laurent Tammany Hall Road, Lot #2 (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York Title 10, relative to the need for approval of individual sewage disposal systems by the Cih• of New York. You should contact city Officials in this regard." 1) 'Why is wetland boundary labeled as approximate and not specifically located? 2) Fill specifications have not been noted on the plan. 3) Please be advised that current codes require a site location plan with a minimum scale of 1" = 2000'. This will be required on all subsequent submissions. 4) Current codes require the dimensions from the property line to the proposed well location. Upon receipt of a submission, revised to reflect the above, this application will be considered further. RM/mh watershed Very truly yours, �bvw 9,0� Robert Morris, P. E. Public Health Engineer RANDOLPH W. LAUREIVT, P.E. Bullet Hole Road Brewster, IY 10509 September 25, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, Ni' 10509 RE: Proposed SSDS Laurent Subdivision - Lot #2 Tammany Hall Road Town of Patterson Dear Mr. Morris: An individual residential subsurface sewage disposal system is proposed for the above - referenced site. In this regard enclosed are the following: 1. PC -1 "Application For Approval of Plans For a Wastewater Disposal System ", dated 9 -8 -97. 2. "Construction Permit For Sewage Disposal System ", dated 9 -8 -97. 3. "Application to Construct A Water Well", dated 9 -8 -97. 4. "Letter of Authorization ", dated 9 -8 -97. 5. "Design Data Sheet ". 6. Four (4) prints of SS -2 "Proposed SSDS - Lot #2 ", dated 9 -8 -97. 7. Money order in the amount of $300.00, review fee. Kindly review the enclosures and contact me with any questions or approvals. Sil W. Laurent, P.E. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION i Street Address Town/Village/City Tax G m id Nu er , 2 WELL OWNER Name Mailing Address yL �` OPrivate D Public USE OF WELL Q - primary 2- secondary P, RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, 0 INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 4000 gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY 0 NEW SUPPLY NEW DWELLING 0 TEST/ OBSERVATION ® DEEPEN EXISTING WELL Q ADDITIONAL SUPPLY DETAILED1�7NG� REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG []GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES , ( NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 2 WATER WELL CONTRACTOR: Name �('W Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI q (DON SEPARATE SHEET siknature) 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 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 suc a manner as not to degrade or oth w e conta inate surface or groundwater. Date of Issue: d 19 1- Date of Expiration L3 2 Z- 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 C__ CD T-T N IM, -se- APPLICATION FOR APPROVAL -OF -PLANS, FOR A.WASTEWATER DISPOSAL SYSTEM Name and Address..bf.. Applicant: A4 �i i, 12 NY ........ .... N�. 10 ---------- Jlapi,e of-Project: Y90FOS rE:50' 0- 3 -._Jocat1c;n,-- T/V/C: itllbiooke Office Cent: PC,qject Engineer: 9,41\� 0"L�FA� .'LAO I S. Address:,.. `10 F509 --!Br ' - : 1 . ewstei.'Y -1Y License Hum* be F: Phone: (914).; 278 - 6108 .... 7 6.. TyDe of 7—Private/Res'id'ential Foo'd Servi ca. •..•Comiiercial Apartment :N6b i.1 e "Home.-- Park Orrice Building. RealL y, S bdivision%. r (�peci Y) 7. is ­,this, project subject' to State' Env i ronment al ' . ' u ' a 1J ty.Rev i ew (SEQR) ? Tyoe Status (Check One)...- "Type- -I.- Exempt 7* Type 11. Uni-iste'd. t 1�� -a Draf �ommmn�al Imp (DEIS)r- red ?' L L act .Statement en.1 re ................ NO H-es DEIS,- b6en completed 'and round acceptable by Lead Agehty'i ............ /A 4n e of Lead Age6cy N,%A % - Is this project" in an area under. the control, of.•local planning•, 2ohing, or other officials, -ordinances? ................. so, have plans :'been sub--itted to such.euthorities?... - .. ... WA a p uthori`L ies?. 'Date Granted: as Preliminary. ' proval be-e.0 granted- by such e Type of Sewage Disposal: Systen, ''Disich.arge ....... ..Surface Hater A' Ground W. at e r s I f surf ace water discharge, what is the, strean. �-class'desi§nation? ....... -/A Haters index:number (Surface) ................ ............ is project located near, a public wa'er,:supp system? name of pater supply Distan WA ce to water supply J_ L TS 7­-0J,-cL site near a public sewage collec -t-ion or disposal s y s t 71? Lance to sewage sy ste-7 m-2 0-,Z Sewage systeim ..D i st L :1 ' a i- - r, observe-,is 2 31 Nlame o- ''ealth -inspector: � J z de s i Sn on S per d aY ...................... G5• Is State Pollutant Discharge Elimination -'System�(SPOES "):Permit required? N 26. Has SPDES Application been subiitted -'to' local_ -. DEC. ' -Off Ice? .... 27, Is any portion or this project - located wi -thin a designate'd`Town or -State wetland ?....... ..._ ....`......... ...................... . 23. Wetland ID Number .: ........... .............. L4 /A 29. -is Wetland Permit-required? ' .... .. . 14.D Has a.ppl i,catioo been nade.,to. Town ' or= Local- DEC OTTiCe? . A. 30.' Does. project require -_ a DEC StreW "Dist'urbance Pe it? ...... .3 Is or was project site used for..agr- icultural activity involving application OT, pesticides to orchards- or"other crops y solid or hazardous waste disposal , ., land; illing, 'sludge application or industrial activity? 32. Is project located•within A-,.000-feet of e *xisi,ence of abandoned. landfill, hazardous waste`., site, salt st„ockpi.le, landfill' sludge-.disposal .site' or any other potential known •source. " of- contariination? :......:.YES or NO __10 DESCRIBE: 33. Is there a local Waster plan. or f le:Nith the Town or.Village? ....... ":.... 1�1D 34. Are co,-,:-iunity water, sewer - facilities.-planned to-be developed within 15 years? 35. Are any sewage• disposal areas in excess .or: -iS slope? ..... T ax? Kap ID h;uc,ber ....... .... ....:. ��. %Y . J ppcoved_ Plans are' to'•b�' returned to: • ..............:. Appl icant 4 En9iin the appl icat.ion : is signed by a person other than tFie .applicant shown -in Item •1 the. ;)plication must be.accompanied by•a Letter of Authorization: Failure to comply.uOth this rovision nay be grounds for the rejection °of any submission. a" I herahy affirm, under o- _na7ty of F-sr. ury;• that information provided on this...; a «.... fo i is true to the •best of u-,,y f;nouleclye and haI fef. False state;rents - -made herein are punishab7e as a Class A Hisd enor ursuent to Section 2 10. 45 0,-_z,-. the Penai T U. °ES ca 0FF1C r,L T I T L.ES fillbroo ?.ce ii1C� Centres INC _ ,`- ,DDnESS. F,re«ster, ';Y 10509 ' SOT Z _PETIT 14 COi7��X DEPAR SNP' OF HEALTH DIVISION OF ENVIROMKagML'ftEALTri7S RidE_,S -- DESIGN DATA :SF=- SUBSUFACE SEWAGE DISPOSAL' SYSTEM FILE M. Games AWt_A-_ L,�tX2NT Address ' [..J Irocatea at (Street) `�ib+?,Jln.t�li� I�-, ._ 1?�i�.� Sec. , . sl.ocr, 3 rot l (indicate nearest cross street) Municipality t�y«�[`j �'LS6; Watershed CPO -f OtA • SOIL PERCOLATION TEST DATA - REQUIRED TO BE SU&%1ITIED WITH APPLICATIONS Date of Pre-soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLA'T'ION PERCOLATION Run Elapse Depth to Water From Water. Level No. Titre Ground Surface In Inches Soil Rate Mart -Stop Min. -Start Stop Drop in Min /In Drop T �! Inches Inches Inches - . OA ,3 2 2 2 5 _._ . - ........ _.. 4 TEST PIT `DATA REQUIRED TO BE SUB,1411TED WITH APPLIQUIUN DEsCP-Ln-1ON- OF SOU-9 EN�L �mm IN, TEST HO -••• DEI:;IE HOLE M. ROLE NO.** G. L. 1392-0 INN 21. 31 41 t- 61 71 121 13' 14' INDICATE LEVEL WE WHICH GROFJYU, P-TER IS ENCOJRT�.ED N-DICAT-P LEVEL TO Wi'lICH EATER LEVEL RISES AFTER BL"LNG E2�*,ICOUNTFRM EEP HOLE OBSF-qtrATIO-Ns HIDB BY: 0 C' DATE: DESIGN' U Rate Used Min/ill Drop: 'O,bo S. D. Usab16 Area Provided cl-f Bedrocnis Septic Tar�: Capacity 125 0 qd1s.' Type of C 30-rPtion Mea Provided By E5 0 r) L.F. x .24," ;Y,,idth * trench A -.) 4 2 a L SPACE FOR USE ny T I.: �.� •: \•! ' :`•: v':./.�':::Y.. •µM.• ^•'� :•::•�: ::� :• :•% ^.`%:man ' \y .. ...... ,....`.... .J ... ......... ...... .. J 1 . .. BATH BEDROOM 4 1 -P, •, y' 8'" x 12'-0** •�.� •� DRESSING' BEDROOM 3. _ WALK ! N 13' -0" x 10' -0* \" CLOSET i�r MASTER BEDROOM - BEDROOM 2 OPEN ' � 1 SECOND F LOO R _ 4828 = .-1344S F 48' ,. KITCNEN .I DINING ROOM p (� MORNING -AGOM Mme. 13' 0-% 12'.0- L_ OPEN ' ABOVE r LtvtNa R0044 � w _ , FAMILY ROOLA 13' ©•• w 181 •0 . 13' 0•' u 17' 0- FOYEM 0 R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES-'-. - .Date 47 Re: Property of LocAted at_ TA "UZ . j (T) io. 2� Lot Sect A Block Subdivision of L112S`�1)RF:7_M__T Subdv. Lot # Filed Map L2 Date _g Gentlemen: This- letter is to authorize a duly li-censed -prof essional engineer 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 a _`�o _ sign i all -necessary papers on my behalf in n L 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, tary Code. "i NI Countersigned: 1,L AWO ,4#-JL MOM and the Putnam County Sani- Ver-Y truly yours, Signed �� Owner of Property UOO TIZA and _77 -- c_ - -- ---- -- -- -- — -.- :- C- I% e- z 0 00 till I VA K T, LN 0 QZ ----------- I'd Wq -67 A