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HomeMy WebLinkAbout1468DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. scanyou rdocs.com 631- 589 -8100 34. -3 -1.3 BOX 14 1 N16 , Lr . t 9 P, ` e, , , Ili i16 A , , I ` 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 AY -1Ir1 i V�^4'b�i'2 t ':� =a- A...i W-1 eh 's_s •"�`"'r'�Y '` x X JC � n' 3..i&aaa:i i "K �'r-i s >YYKlSYIauaJ.� •.. -..• X �C Y o rv, X X �%3.n'-.,� ors? - - -� u f X0,19 78 I.w 1 6 1 Fc( Pa .,.Joe rl rners 84 1 62 HS all?6 ILar, 48 AA o. R Pond - I.w 1 6 1 Fc( Pa .,.Joe erna Raymond N 9 corn KILE -a el Go •CARMEL HS 47 unly Courthouse nty Office Building 57 312 bit Ludington onument 8 Glenda 6 Till '-Ul Fost W- Putnam Plaz S.C. in. Brewst Heights Carm Hills.., .... ..... . 6 N 0 A 6 Drewville Hopi Corr fJ LJ on tiVE Putnam q0SPHS1 Center Vr /A: 4,52§�,-,! 202 Aroj" DPA- NININ �r rl rners 84 1 62 HS -41 48 AA R 52 erna Raymond N 9 corn KILE -a el Go •CARMEL HS 47 unly Courthouse nty Office Building 57 312 bit Ludington onument 8 Glenda 6 Till '-Ul Fost W- Putnam Plaz S.C. in. Brewst Heights Carm Hills.., .... ..... . 6 N 0 A 6 Drewville Hopi Corr fJ LJ on tiVE Putnam q0SPHS1 Center Vr /A: 4,52§�,-,! 202 Aroj" DPA- NININ �r 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-- `I S B D-- I Date PROPOSED STRAW BALE DIKE �ln�tui� do Title PROTECT 0 550,5 rAMMANY HALL I:ZOAt9 yo/z# CLIENT : ANNE LA U14?,E N T rA M MA N'1' HALL K OA t:;' .0_opt.g ft. Nf 12 0 C, 1-5 A RAN E I NT, Pi NY / 2-5363 DRAWING MU PKOP05�0 5505 LAUI-?,eNT 6UE5010510N - L0743 SCALE DATE DRAWN BY': TK CMCKED BY SUB No.: Iwo ---3 - DRAWING No.: 1 1 1 1 / 1 1 \ Qth COOM 00°0 15-xpANSio bp- ,q� TP \ ET ` . JutcrION ` 52 L.F Aesa r, z. \ TP- � TCAL -1 \ Z --_ Cp 601-1 a X250 IN 00, I � ` \ \ \ ` 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: