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BOX 14
1 N16 , Lr
. t 9 P, ` e, , , Ili i16 A
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1 •%
PUTNAM COUNTY DEPARTMENT OF HEALTH
_ - IVISI.OI�T.I E.EIVVIIZONMENTAL _HEALTH -.S RV C S..
CERTIFICATE OF CONSTRUCTION COMPLIANC + E TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # p
=1
9 S'
Located at 1ob- Town or Village 9 Al-T* 5 ok-J
Owner /Applicant Name 649FOR&- MO Il-E�40 Tax Map 0)4' Block '/ Lot 11
Formerly
A HM5 I-Aip-es -fl
Subdivision Name I_AU9-91'V
Subd. Lot #
Mailing Address PP k k 641 O W5 Zip
Date Construction Permit Issued by PCHD
Separate Sewerage System built by P-A1\' JEF� 40 rfl� Address 14 Bk*J%15-A'J4t
Consisting of 1 Gallon Septic Tank and 6-71, VF AM - T�-5 M c-H
Other Requirements
Water Supply
T Dom' tru? pWH W AIM
Public Supply From.
or: 5C Private Supply Drilled by MIU' MM lWW
i
i� iD �NC -�
Address
Address 101b F "Al QPAWO 044 17,%�
Has erosion control been completed?
Number of Bedrooms Has garbage grinder been installed?
v v�
Ho
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 regulatiogs of the Putnam County /pep4qtment of Health.
Date:
Address
P.E. A R.A.
5(91 i4
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 subject to modification or change when, in the judgment of the Public Health Director, such
revocatiXm4sificati%0 change is necessary.
By: Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
t
r
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
0reV10
Owner or Purchaser of Building
PS , 'a.nc
Building onstructed by
. 1� —KC-1 rn vy,<> n \4 ��Q� R4,
Location - Stree
Building Type
Tax Map Block Lot
�f 'e�15 V_, VJ
TownNillage ll
Subdivision Name
Subdivision Lot it
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
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
any part of said system constructed by me which fails to operate for a 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.
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to y operate was caused by the willful or negligent act of the occupant of t ebuilding ut' ' 'ng the
system. h
Year Signature:
General Contractor (O ner) - Signature
Corpora ion Name (if corporation)
Address:
State Zip
Title: �T( 5'N--,
?4 14 i 6{ J Me- J -
Corporation Name (if corporation)
Address: I �(� �•f'r�a �j� ���
State w,J �v e dip Lo �0 n
Form GS -97
1, LAURENT ENGINEERING
�� ASSOCIATES, P.C.
York- 10509x
20 M 11tow
� / \ 'Brewster, New -. . -
HARRY W. NICHOLS JR., P.E. ;� (914)278 -6108 - (FAX) 278 -2658
CONSULTING SITE ENGINEERS
September 9, 1999
Mr. Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS Compliance - George Moreno
Laurent Subdivision -Lot #3
135 Tammany Hall Road
Town of Patterson
Dear Robert Morris:
Enclosed are the following:
1. Five (5) prints of SS -5 "As -Built Plan," dated 9 -9 -99.
2.. Certificate of Construction Compliance for Sewage Disposal System," dated 9 -9 -99.
3. "Guarantee of Subsurface Sewage Disposal System," dated 9 -9 -99.
4. Well Completion Report, dated 10- 30 -98.
._. _. _ ..._ _....: _.....__ .._.� . 5.. Laboratory_Report, dated 8- 16 -99.
6. Application Fee in the amount of $200.00 payable to Putnam County Health
Department.
We would appreciate your review, approval and issuance of the Construction Permit at
your earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
OV-7
Harry W. Nichols, Jr., P.E.
HWN:JM:his
99003
YML ENVIRONMENTAL SERVICES
J. Kear Stree�
yoTktown Heights, N�Y`.`10598
.
24.-2800
Albert H. Padovani, Director
LAB #: 93.903993 CLIE, #: 10947 NON ST AT �ROC PAGE 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RA "Al JE� HO�ES ImC.
106 BREWSTER SQ. 175
BRE":S�ER, NY 10509
DATE/TIME REC'D: 08/05/99 09:40
REPURT DA�E: 08/16/99
PHONE: (914>-228-4328
SAMPLING SITE: LOT 3 TANMARY HALL ROAD `SAMPLE TYPE..: POTABLE
: PR�SE��ATIVES: NONE
COL 'D BY: MARTIN LAURENT � TEMPERATURE..: < 4C
KIT TA� COL|FORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PRO�EDURE RESULT NORMAL - RAMGE
PUTNAM CNTY PROFILE
08/05/99 MF T. COLIFOR� ABS�NT /lO0 ML ABSEmT
08/05/99 LEAD (IMS) <1 ppb 0-15 ppb
08/05/99 MITRATE 0ITROG
08/05/99 NITRITE NITROG <0.O1 MG/L N/A
08/05/99 IRON (Fe) <0.06O MG/L 0-0.3 mg/l
08/05/99 MANGANESE (Mn) MG/L 0-0.3mg/l
O8/05/99 SODIUM (Na> 8.75 MG/L N/A
p "4 UNITS
08/05/99 HAR�WESS,TOTAL 6 N/A
0G/05/99 ALKALINITY (AS 30.0 MG /L N/A
08/05/99 TURBIDITY (TUR <1 NT O-5 NTU
COMMENTS:
BACT THESE RES��TS INDICATE THAT T.E WATER (WAS %OT> OF A
SATISFACTOR� SANITARY QUALITY ACCORDIK�-�u THE NEW YORK STATE
AND EPA FEDERAL DRINKING �ATEF� 5!ANDA��S, FOR THE ��RA��[ERS
TESTED, AT THE TIME OF COLLECTION.
Pb/Cu LE�D limits for p�blic schools are set ut 15 ppb.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of thei.' di ib:tion points have a LEAD value of mure
than 15 ppb and a COPPER value of 1.3 m /L, else water
treatment must be undertake, to reduce the waters corrosive
potential.
Fe/Mn If both iron and manganese are present, th otal valu�
combined shal l not exceed 0.5 mg/L.
Na No limits For Sodium
that for people on a
contain no more than
moderately restricte
is sugges�ed.
are proscribed. Suggested g�idelines �tate
sodium restricted diet,the water should
20 mg/L of Sodi:m. For those on a
d diet, a maximum of 270 mg/L of Sodium
10�p
9139
9146
2037
2037
YML ENVIRONMENTAL SERVIC£S
321 Kear Street
York. ieigt��� ��10598.
(914) E45��7�}�- -~--
Albert H. Pado"ani, Director
LAB #: 93.903993 CLIENT #: 10947 NON STAT PROC PAGE 2
-------- ~m --- m ------------------------- -------------------------- ---------- n.-
RAMJET HOMES INC.
106 BREWRn�v SQ. 175
BREWSTER, NY 10509
SAMPLING SITE: LOT 3 TANMARY HALL ROAD
:
COL'D BY: MARTIN LAURENT
NOTES...: KIT TAP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCExURE
DATE/TIME TAKEN: 08/05/99 09:00
DATE/TIME REC'D: 08/05/59-090C*)
REPORT DATE: 08/16/99
PHOW: (914)-228-4328
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..:A 4C
COL[FORN METH; MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RESULT NORNYL - RANGE METHOD
PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pm IS 6.5 TO 8.5,
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
CONCENTRAT101, BlYTH EXPRESSED AS CALCIUM CARBUWATE, IN MG/L, THE
HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE
SOURCE AND TRE&MENT TO WHICH THE wATER HAS BEEN SU8JEC7ED.
SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L
MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLTGRAM PER LITE`..'
SUBNITTED BY:__
Alb
Dir
[.(ASCP)
ELAP# 15323
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address: 7.707 3
75L11 Al P & -14.1 A ,
Town/Village:
/, �
Tax Grid #
Map 1A. Block Lot(s)
Well Owner:
Name: 6 Address:
Ralm je. vnt.e.
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 - Open hole in bedrock _ Other
Casing Details
Total length ,ft..
Length below gradeft.
Diameter Tin.
Weight per foot �Ib /ft.
Materials: Steel _ Plastic _ Other
Joints: _Welded Threaded _ Other
Seal: Cement grout Bentonite Other
Drive shoe: 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 Compressed Air
Hours d
Yield IE gpm
Depth Data
Measure from land surface- static (specify ft)
During yield test(ft)
Depth of completed well in feet
Well Log
If more detailed
information
descriptions orOf
sieve analyses ... _�
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land surface
sec Gard ��
(</nre%
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type Capacity
Depth Model
Voltage HP
Tank Type Volume
Date Well Com eted l�j
6 P �
Putnam County Certification No.
�6
Date of /Report
/l �/l �
Well Driller (signature)
�r �, &ALL
NOTEr Exa ® location of well with distances to at least two permanents an arks to be provided on a separates et/plan.
Well Driller's Name / IV/
Signature: r
Address: /LY/Si �. v %� / !/ �t�Ca�, /�✓
Date: /;' ,!- w
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
Ii I �xPA �• /'uNNC�Q> I -
i
1l7 5 /0
?ll0 9
4 Y. TANK
✓G. h7i fZ95
_ �.
t
Fy- rlw 1 4 b�f�oaM
1 G,
i
SOON@
Me /3 '
I�
A" 1P
r.
4
H2O�L.Z.. RoA�7
i
tgent of Real*
pntnas County► Dept th Ssrvioea
Division of Environmental $eat.
ae With
aDD=aved Hated for oonforman oY the
ulatjons
appiioa, a les t>�ntput o'W y ;j7 Debar �
DIMENSION CHART
(in ft.)
No.
..A
B
Z
70..0
7 & -0
4G•o
96.0
SO
8
47.0
67.0
73.0
/D
0.0
77 0
82�O
12
72.0
X60
70.0
/5
0.
75'0
9/•0
/7
!3 Z•0
87.4
ors , / TA---Err. c,-04 Vkf.N jA---H11 i`)
1 represent that I .am wholly and complately'responsible for the design and location of the proposed systerh(s); l.) that the separate sewage .di ' sal system .
above; described will by constructed is shown on
the approved: &M,
nion ment there to and in accordance with the standards, rules a regu ;ons 0,
• nam
County .t)epa►tmant of Maaitt% arid that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
the wtimittad to the - Oepartment -und=er wrlttee guarantee will be furnished the owner, his successors, hehs or assigns by the builder, that said builder will
place in `tisioa :operating, condition any .part of said sewage disposal system during the period of two (2) years Immediately following the data of the issu-
ance of the approval of the Cartificato of Construction Compliance th original system or any repair thereto; 2) that the drilled well ~Ibed . above
will be located as shown on the approved plan and that said well will be I st I In accords e titer r rules and rpu ons of the Putnam
Couflty Oepartroars of Health.
Oat* �/ - Signed p.E.1�f R.A.
Addratt�/�1.�(MI��% �T ense No2.'IL�I.
APPROVED FOR CONSTRUCTION.: This approval expires two y rs o the dat - ed unless construction of the building .has been undertaken and is
revocable for'pu or. may 'be amended or modified when consid ry by a Commissioner of Health. Any change or alteration of construction
"auires a :new rmi proved f0► disposal" of domestic sa it � e, a rivate ;water supply only.
N'• Date '� I3Y Title
10/.88 . , "
- PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Street Location
Town'�7rF�s�iv
TM r 3# -- B --
1. Sewage System Area ;
a. STS area located as per approved plans ...........................
b. Fill section - date of placement
3:1 barrier Loth. Width Avg.Dptli
c. Natural soil not stripped ................... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 100' from water coursehvetlands ...... ...............................
II. SewaQe Svstem°�-
a. Seftici size - 1,000 ...... 1,250 .......other... .............
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Wistribtuion Box
1. All outlets at same elevation -water tested .................
2. Protected below frost .................. ...............................
3. Minimum 2 ft.Original soil between box & trenches
Junction Box - properly set.. .................... .�.............................
ength required 7 Length installed _E 7;7—
2. Distance to watercourse measured-f- 2ao Ft..........
3.Inst e c rdingVbI ... ...............................
4. St Ve"h acc6 - 1/32" /foot .............
5. 10 om propertft.= foundatio ns..........
6. Depth of tr rich < 0 ' es o s ace ..................
7. R to e fo siot 1.0 0 . .....................
8. Si of 4 - 1%' diameter clean ....................
..4.. De o - gr- avel -in trench -12" minimum..............::
..:
10. Pipe ends capped ..................... ..............................�
g. Pump or Dosed System
Size ot pump chamber ................ ...............................
2. Overflow tank ............................. ...............................
3. Alarm, visual / audio .................... ...............................
4. Pump easily accessible, manhole to grade .................
5. First box baffled .......................... ...............................
6. Cycle witnessed by H.D.estimated flow /cycle...........
III. House/Buildin
a. House located per approved plans ... ...............................
b. Number of bedrooms ............... ,v ►s .`r; ..............
IV. Well 0 dcwn 54e )ni
a. -Well located as per approved plans ..........................
b. Distance from STS area measured -r- v o ft...........
c. Casing 18" above grade .................. ...............................
d. Surface drainage around well acceptable .......................
V. Overall Workmanship
x
a. Boxes properly grouted.... ............. ............................... �
b. All pipes partially backfilled ........... ...............................
c. All pipes flush with inside of box . ...............................
d. Backfill material contains stones <4" diameter ..............
e. Curtain drain & standpipes installed according to plan..
f. Curtain drain outfall protected & dir.to exist waterco
g. Footing drains discharge away from STS area............
h. Surface water protection adequate ... ...............................
Date: /
Inspected by:
Owner - A -09 e 17-
Permit # p -- I e� _ c�
Subdivision Lot?' 3
f
X0,19
78
YES
NO
COMMENTS
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Date: '10—
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
'Tel. (914) 278-6130 Far (914) 278-7921
To: 1A, !" I/�g, Fax', -?q-3 0 3 Z3)
S�-
No. Pages
(Including cover sheet)
BRUCE R. - FOLEY.,
Public Health Director
From:
Putnam County Environmental Health
Notes/Messages %%L%���� /4'S
In the event of transmission/reception difficulties, please contact this office.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Dlvloles of EavIr amestal Hedth Servlbe•. Carmel, N.Y. 10512 Eq*_ to Provide Pewit g
CONSTRUCTION PERMIT FOR SEWAGE DEPOSAL SYSTEM
S•hdivieien Name 4:
Owser/AppBmot NameAat j:,::: 1� T
out CEWMCATE OF WU CE
Pessaslt f - /
Frown at Village .
Tax Map Block '-
Renewal_ ❑ Revlabn ❑
Dote of Prevloea Approval
maug Aadroma IAIt/ M.AN -( ' +Q LL &An Town �A.""f"TEK' SC1J zip 12_S4--2
Dat. Subdivision Approved Fee Enclosed ® Amnit„r
Buslike Type ��i l CEN-U AQ 1.- Lot Area Fail Section Only Depth Volume
Number of Bedio•me Li Design Flow G P D PCHD NoliBcadon Is Regafred FAD Is oomph
Separate sewerage system to mm" of 12% h 1 GWI. S.p& Task sad
To be c•mst,aded by TPi D Address
vats supply: Pub& supply From Address
an 4 _M.W Sq*ly Drilled by Address
Other Reeahem .La i I t71'; e r CO TA I N PEA 1 ni
1 represent that I am wholly and completely responsible for the design and location of the proposed system "); 1) that the separate sewage disposal system
dar
above described will be constructed as shown on the approved amendment there to and in accordance with the stands, the
and regulations of • u nam
County Oepartment Of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner Of HNlthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builds, that said builder will
Place in good operating condition any part of said sawago disposal system during the period of two (2) years Immediately following thedat• Of the isw-
anco of tM approval of the Certificate of Construction Compliance oI the original system or any re *irs�theroto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be irlst` III `in�accord�nce WK a sta ar rules and ragu a I-1� I ns of the Putnam
County Department of Health, , I l ✓
Date Signed l P E y R A
--7 —
1 2Q, l can. No �
APPROVED FOR CONSTRUCTION: This approval expires two y rs
dat
sued unless construction of the building has been undertaken and is
revocable for cause or may De amended or modified when conside►
efih
by
a Commissioner of Health. Any change or alteration of construction
Rev.
requiros a now arm Dproved for disposal of domestic serail
�/
a
private water supply only.
to /pp
Oate_T_ By
Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New.York 10509
. (914) 278 -6130
APPLICATION TO- CONSTRUCT, A -WATER --WELL
PCHD PERMIT
WELL LOCATION
Street Address
Town/Village/City
Tax Grid umber
. �_�►
WELL OWNER
Name
1
Mailing Address
E9Private
O Public
! OF WELL
primary
2 - secondary
&RESIDENTIAL
® BUSINESS
® INDUSTRIAL
® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify,
b INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED, - /EST.
O REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION
MNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
OF DAILY USAGEa gal
12. ADDITIONAL SUPPLY
I
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
--
WELL TYPE
DRILLED
DRIVEN
ODUG O GRAVEL O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES iC NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name Yj�jC� Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A NO
NAME OF PUBLIC WATER SUPPLY: N TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: j•(��
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID
19ON SEPARATE SHEET P
(date) (s 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
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 ="_ g operations be contained on this
property and in suc a manner as not to degrade or cont dwater.
Date of Issue:. 19 g.�
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
DEPARTMENT OF HEALTH
Division of Environmental Health Services
�I (10 wyn kiwkl
trrewstcr, Nov York 10509
11,4. (914) 278.6110 tit.► (') 1,1) 278 - 7921
Theresa Ryan
Laurent Engineering
Millinouk Ulllcv C1.r.
Route 22 & Millbrook Road
Brewster, NY 10509
Dear Ms. Ryan:
_ niRUC;E R.' FOL-EY ' ... .
Acting Public Health Director
May 1'l, 1997
Tamany Haft Road
(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 wellands rogulalions
i't►u r�lluulel e;utttncl lu4t►1 Wctllauels ulliclals ut this rcg:uel."
"You are referred to Article 128.1 of the official compilation of Codes, Rules and Regulations of
1110 .Plato of .tJcw � "urli; Title 10, relative to 1110 nucd lur approval of ltulividual scwagc disposal
systems by the City of New Yor)!, You sbokild Pontact city Officials in this regard:'"
Curtain drain is to N shown on prolilt'. it is alro'llgh, El(h"i.wit 111m
Iho curtain drain is a minimum o1' 10 legit from the; septic tank.
'1'Itc Dept, of l;nvironrnncntal indicate a percolallon rate o!' I0 -20
min /inch witnessed on Nlarclr 27, 1996. l' ovise, accoi I -din,
.6" Curtaui•drain standpipes have not been shown on the plan.
4-' Curtain drain cover is to be noted as geotextile material or equivalent.
Upon receipt of a submission, revised to reflect the; above, this application will be considered
further.
Very truly yours,
Robert Morris, P. E.
Public Health Engineer
R \L ih
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES .
Date
Re: Property ofI�IN�y��T�
Located at
(T) JAA' 77�12.S0)\4 Sect.i on_�__Block Lot.
Subdivision of L/— ()fZr---7N j-
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize k7_Ak CVL-F 4 VU
a duly licensed •professional 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
Departdle'z7e" of =Iea'1tFi 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.
Very truly yours,
Countersigned: Owner of Property
...
m
1;40ti,IA Ni 14,,&,LL 12o P
Address
Telephone
'd
Town
1a S `3 i °
Telephone
PROPOSED BUILDING
EXISTING GRADE
PROPOSED GRADE
PROPOSED SPOT GRADE
PROPOSED ROOF & FOOTING DFLA-
PERCOLATION TEST LOCATION
TEST PIT LOCATION
EXISTING WELL
PROPOSED WELL
Putnam County Department of Health EXISTING SSDS
bivision of Environmental Health Services PROPOSED SSDS
Approved as noted for conformance with EXISTING TREE LINE
VP I,Xab e Rules and Regulations of'the EXISTING STONEWALL
Co �tvlle;alth Departmqjfit.,/ I; S. F. PROPOSED SILT FENCE
4 -V V— V--
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I Date PROPOSED STRAW BALE DIKE
�ln�tui� do Title
PROTECT
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DATE
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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 #l! -/
WELL LOCATION
Street Address
-
Town/Village/City Tax Grid Number
-"4. -3- ?�
WELL OWNER
Name I
L Ad
Mailing Address
,W 44i_i_
OPrivate
D Public
E OF WELL
primary
2- secondary
G-RESIDENTIAL
0 BUSINESS
D INDUSTRIAL
0 PUBLIC SUPPLY Q AIR /COIJD /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
0 ABANDONED
❑ OTHER (specify,
p
AMOUNT OF USE
YIELD SOUGHT
5 gpm /# PEOPLE SERVED3 -5 /EST. OF DAILY USAGE E gal
REASON FOR
DRILLING
11 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION GI ADDITIONAL SUPPLY
EINEW SUPPLY NEW DWELLING ❑ DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
NEW
WELL TYPE
®DRILLED
13DRIVEN DDUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L,4L)W_I E
Lot No.
WATER WELL CONTRACTOR: Name -ro[2 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A NO
NAME OF PUBLIC WATER SUPPLY: N /A TOWN /VIL /CITY
.DISTANCE TO-PROPERTY. FROM NEAREST WATER ;MATN: -_
LOCATION SKETCH S SOURCES OF CONTAMINATION PROVIDEBD �
,® ON SEPARATE SHEET 1 'i
(date) (s natui )
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 dri g operations be contained on this
property and in suc a manner as not to degrade or of erw a cont am' to surface or grqundwater. e&,v Date of Issue: 19q�
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
S. IS a Draft Emrironnental Impact .Statement (DEIS) required? ..........
9.�,Nas DEIS been completed and found acceptable by.Lead Agency? ............
i 0 . Name of Lead Agency
this project in an area under. ;the control of -local planning, zoning,
or other officials, ordinances? ...............t /5
2. Ir� so, have plans been .sub;mitted to such :authorities ?... _ _ ... N/A _
3. 'as preliminary approval bepep granted by '.such authorities ?�_ Date Granted :_
Type of Sewage Disposal. System Discharge...... Surface Water _ Ground Eaters
�. Ir' surface water discharge, what is the stream class designation ?......... N ZA
�. 'Haters index number (surface)
Is project located nea „r.. a public water supply system? N. ,S
Yes, nac,e or water supply Distance to water supply
!.s project site near a pu.blic sewage collection or disposal syst:.,-� ?.....
tare o1T sewage system _ t / - ..Distance to sewage syster,
Date observed:
23. t�'ame of Health Inspector: •I,d N LSKL_r_P
J
-oject design r -lo, (gallons per day) ...................... __� -.._..
APPLICATION FOR APPROVAL,.OF PLANS FOR A.WASTEWATER DISPOSAL.SYSTEM
Name. and Address bf: Applicant:. 1-' s= r Ui2t =�IT-
dAQ
FA, —T C—:: 5>,y
N`1 12 -5�
. 2... Name of Project: pro r") St�S
3.._•-Location T/V /C: �2
4. Project Engineer:
5• Address:
p
License Number:�Zl Phone:
;.
6.. T De of Pro.iect:
X Private %Residential Food .Ser.vice
Corenercial ,
Apartments_ Institutional -:_.
;Nob.i,le ..Home. :Park .::.
Office Building. Realty Subdiv.i.si.on:.;.
Other .(specify)
Is this project subject' to State Envi ronmental •4`ual ity Review
TvDe Status (Check One) Type I. EXenDt
.(SEQR)?
Type II. U n 1 isted,
__A___
S. IS a Draft Emrironnental Impact .Statement (DEIS) required? ..........
9.�,Nas DEIS been completed and found acceptable by.Lead Agency? ............
i 0 . Name of Lead Agency
this project in an area under. ;the control of -local planning, zoning,
or other officials, ordinances? ...............t /5
2. Ir� so, have plans been .sub;mitted to such :authorities ?... _ _ ... N/A _
3. 'as preliminary approval bepep granted by '.such authorities ?�_ Date Granted :_
Type of Sewage Disposal. System Discharge...... Surface Water _ Ground Eaters
�. Ir' surface water discharge, what is the stream class designation ?......... N ZA
�. 'Haters index number (surface)
Is project located nea „r.. a public water supply system? N. ,S
Yes, nac,e or water supply Distance to water supply
!.s project site near a pu.blic sewage collection or disposal syst:.,-� ?.....
tare o1T sewage system _ t / - ..Distance to sewage syster,
Date observed:
23. t�'ame of Health Inspector: •I,d N LSKL_r_P
J
-oject design r -lo, (gallons per day) ...................... __� -.._..
G5. Is State Pollutant D_ischar.ge Elimination,.. S.yst:e.m;;.(SPD- E5)::Pernit requ�`red7 ":
26. Has SPDES Application been submitted 'to local DEC 40ffice?
27. Is any portion of this. project located within a designated`Town or State
wetland? ................................... ..........................•.... N.L�
i
28. Wetland ID Number ....... ...... .................... ............ ........ N1A
29. -is Wetland Permit -required? .............' ............................... ND
Has application been made to Town or Local DEC Office ?................
....
30. Does project require a DEC Stream Disturbance Pe i,it? h
31 . Is or was project site used for..agr- icultural activity involving application
OT pesticide$ to orchards-or other crops, solid or hazardous waste disposal,.,
land;illing, sludge application or industrial activity? YES "or•.h0. Nr
32. Is project located -within 1,,000-feet, o; existence of abandoned. landfill
hazardous waste, site, salt stockpile, landfill; sIudge.disposa1 site or'
any other potential known •source of contamination? .............,.YES or NO NC
DESCRIBE:
33. Is there a local master plan or fi le . with the Torn or Vi. 1 l a'ge? .....
3;. Are cow: -nunity water, sewer facilities planned to be developed within 15 years? �Aee,
35. Are any' sewage disposal .areas i -n- excess of 15 --. -
J - -.I ax Nap ID Numberr F ...........................................................
37. Approved Plans are'to'be returned to: ................. Applicant ,C: Engineer
r• the application;is signed by a person other than the applicant shown in Item .1, the.
°pplicat!on muss be accompanied by a Letter of Authorization: Failure to comply with this
Df'ovision may be grounds for the rejection °of.any submission.
I hereby affirm, under penalty of perjury;- that information provided on this
for;,r is true to the best of my know7e -8.ge and bAI fef. Fa Ise sta`ter,ents "n, zde-
here in are pun ishab7e as a Class A Hisde�reanor pursuant to ect ion 210.45 of
'the Pena7 <Law.
�.�.-G,�AT URES 4 0 FICIr,L TITLES:
LING 11 ADDRESS: