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HomeMy WebLinkAbout1487DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 34. -3 -28 BOX 14 rm 6L L. Lim J r %'l ', a . n f 01487 186 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Mast Provide P.C.H.D. Permit " z:::r , .:CERTIiIC 7L.. C' (V1VS7'ldtl( t'lUPI.( UMYi7:lAPit `rUR SEW.At E- D15r05A7: SYSTEM Located ate' �i-U ii D AD, Zoo=Tn P� �. Owner /applicant Name � �4 'Formerly Mailing Address e0 A Q Zip . G� • g /fir . . Separate Sewerage System built by y +`-�94'>� Address Consisting of ' ®O, 0- Gallon Septic Tank and RJGNS Water Supply; —Public Supply From Address �1 or: Private Supply Drilled, by Address R%. �.`� C /%�i �'! —T� LEI S/ Z Bullding Type —Has Control Been Completed? Number of Bedrooms. = Has,Gaibage Grinder Been Installed? .Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially ass n. the plans of the completed work f copies of which are attached), and in accordance with the standards, rules'and regulations, in accordanc with he filed plan', and the permit issued by the Putnam County Department Of Health. Dated / Certified b w P1 A. Jr/ Addre -- License No. Any person occupying premises served by-.the above system(s),- snall' promptly take such action.as may b necessary to secure the correction of any unwnitY conditions Cesuiting.from such ufaye:. Approval of the separate sewerage sy;tom•shail become null and void atsoon as .a puW, sanitary sewer becor: available and the approval of the-'private water iupply shall,becoine_ null and vald when a, public water supply becomes available. Such approvals . _ subject to ficatlon cnange- when, in the Judgment of the Comml stoner of Health,'su" cation, rriodIfq15APon or change is necessary, bate B Title f F K f � 1 to ke Zs OE 6 N ev c4 � ® d� "1- �r� - • `. A li ` _ _ ,1 u p )4- / •, i zt - } e. 1'• r; 4. CI SCHEDULE OF -TANC E•S _ ,y's A TO B 48.5' `; :, tr TO A TO C i.1 • 1 A TO 1 19.. 1" '+ 8 TO I Co 1 • 8' A TO 2 u 41,y' 13 TO 2 1oD.(J' A TO 3 G1.2' 1!� TO 3 98.3' A TO y !a0. 1' TO 4 A T a 5 5 9,► 6 To A TU Y 60.2'i l3 TO G g9. 3• A TO -7 Cat. 0 TO -7 86. 9' A To g To g 85, 2' A TO 9 r GS. I' Q TO c3 83. 6' SCNOQLL i0V TRENCH LENCT -H L= 1 IQ• S` �'.. 5= 29.2 '32 0 O= 33•`9 � � d = 32.5' F'= 34,0' ! W- Q= 34.3' X= 31.5' i NOTES s• LOF r Owner or Purchaser of Building 1.• 0�T__ . ei>'-_ PP-0, "5kn'> Building Constructed by suz,/_ LZ `T //;� s �eo Location - Street Municipality Building Type -7 Section Block Lot Subdivision Name Subdv. Lot ## GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 success- ors, 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 initial use of the sewage disposal 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ,.....a.tiori.: o.f ._the Division of Environmental - Health -S-ervices. - of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. , Dated this day of � v41 19go Signature Title Corporation NameV(if Corp.) Gio 6U A�6 Ad res THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health II. IV. V. VI. APPENDIX C / FINAL SITE INSPECTION Date S/ /fir 0 P - -, -� -& ( IM 4 OR SUBDIVISION LOT 4 Inspected by/t(Q_ OWNER _ , ._ . _...... r _._.. - . _ . SEWAGE DISPOSAL AREA a. SDS area located as per approved Plans V b. Fill section - Date of placement 2:1 barrier- LGTH WIDTH AVG.DPTH c. Natural soil not stripped d. Stone, brush, etc., greater than 15' free SDS area. e. 100 ft. from water course /wetlands. SEWAGE DISPOSAL SYSTEM,. - — ___-, a. Septic tank size ,'- 1,006,-) 1,250 b. Septic tank instal-led l -evel c. 10' minimum from foundation d. No 900 bends, cleanout within 10 ft. of 450 bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX --properly set g . TRENCHES 1. Length required - Length installed vet° 2. Distance to watercourse measured_ ft. 3. Installed according to plan k 4, Goy 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet frcn property line - 20 feet - foundations ' 7. Depth of trench < 30 inches fren surface 8. Roan allowed for expansion,.50% 9. Size of gravel 3/4 - 1 " diameter ✓ ' 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped / h. PUMP OR DOSE SYSTEMS 1. Size of chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pum p easily accessible manhole to grade, 5. First box baffled 6. Cycle witnessed by Health Department estimated flaw per cycle HOUSE ' a. House located per approved plans. V/ b. Number of bedrooms 3 % WILL a. Well located as per approved plans b. Distance from SDS area measured ft. c. Casin 18" above grade. d. Surface drainage around well acceptable. OVERALL WORKMA.SHIP? a. Boxes properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" in diameter / a e. Curtain drain installed according to plan F f. Curtain drain outfall rotected & dir.to exist.watercours g. Footing drains discharge away fran SDS area h. Surface water 2rotection adequate i. Errosion control provided on slopes greater than 15 %. 9i 1C y .e -I W Y �� WLLL UUr1rLL11UV r rLrurkl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - - WELL LOCATION SiR " OOAESS: WNW TAX GRIO NUMBER: WELL OWNER E' P JADs: PflIVATE O PUBLIC USE OF WELL 1- primary 2- secondary ESIDENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS 0 FARM O TEST/ OBSERVATION O OTHER (specify) 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED .__C__/ EST. OF DAILY USAGE al. REASON FOR DRILLING ANEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH �0 ft. STATIC WATER LEVEL _s _ ft. Z 3 DATE MEASURED — DRILLING EQUIPMENT O ROTARY 15KOMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION O OTHER (specifyj: WELL TYPE O SCREENED O OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH YQ ft MATERIALS: &STEEL O PLASTIC O OTHER LENGTH.BELOW GRADE -3 9' tL JOINTS: O WELDED "REAOED O OTHER DIAMETER in. SEAL: CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT Ib. /ft DRIVE SHOE -01ES ONO UNER:OYES Q10 . SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH To SCREEN (it) DEVELOPED? FIRST O YES ONO _ HOURS - SECOND -- . ,..._,... _ . __. _ .. _..... __ _., _.. _ _ _.... _. _. -- -. _.. - -. _- _ . _. .. _ ._ �_. _� .... _,._. . GRAVEL PACK ❑ NOS GRAVEL SIZE DIAMETER OF PACK in. TOP OEM K BOTTOM OEM It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED 1. tests were done is in- � COMPRESSED AIR formation attached? ❑ BAILED ❑ OTHER ; ❑ YES O NO If more detailed formation descriptions or sieve analyses LL LOG are available, please attach. p Y rDEPTH FROM FACE Water Bear- 'ng Well Dia- n °1cr FORMATION DESCRIPTION GOOF . tt. WELL DEPTH ft. DURATION hr, min. DRAWOOWN It, YIELD gpm. Land ace Q 110 '`O Aa- 0 61 ' WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES O NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE - CAPACITY GAL. - PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME ' � f� �1 DA ' _ G ADDRESS / L , �2 sIGF %� d /(� , i PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES -0 John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of �1 INSPECTION NAME Orig. Routine / Orig. Complain ADDRESS �C1 / /�� /�.r �7 6�f� Orig. Request No. Street Municipality ((T)(V)(C) Compliance f! ' Complaint Comp MAILING ADDRESS P. � Final O. Box Post Office Zip Code Group Illness _ Construction TELEPHONE _ Reinspection PERSON IN CHARGE ��� ,i i� Field, Sampling Only OR INTERVIEWED ,/,,c,/Field , Conference Name and Titt -e" DATE �% �r _ TYPE FACILITY Other TIME ARRIVED G 67- X4—, TIME LEFT /,f Explain FINDINGS: /-- & / - `" / '44 Ld '' / �C" fT' /' i7- _ �� , /S' ?' "'/C' A.- /,?,-/ / /.O ! s%P 'a si i , l i'C. w . n / i•-- 1 / � r, � C.� � / -G �`✓r G . �� � ` .a � // a 60 t �' 1 /i A .!-�� � ,-- ,� .�-- .� � �> ''`" .i-= i'.�.n s ,- `rte...., S ..� �° �.f •,��` r..,��- -6, INSPECTOR: Signature and Title --`' PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: r TELEPHONE: 1 PETER C. ALEXANDERSON County Executive ENID' L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL Jr., P.E. DEPARTMENT OF HEALTH Director Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 August 2, 1988 Loft Corporation Pumphouse Road Brewster, New York 10509 Attention: John Forbes, Pres. Re:' Lot X61 Burdick Glen Bullet Hole Road (T) Patterson TM #73 -3 -25 Permit P -33 -86 Dear Mr. Forbes: An inspection of the final grading and seeding on the above - mentioned lot was conducted on August 1, 1988. The following items were noted: 1. Erosion in the area of the sewage disposal system continuous t-o_,be a. -.'p. .o b. 2. The swale between the driveway and SSDS was not constructed. 3. Erosion is a problem where the gutter drains discharge (see attached Field Inspection Report and diagram) Please make the necessary repairs to the eroded areas. Also the swale must be constructed as shown; and previously dis- cussed/and pipe the gutter drains so that discharge is in a stable area. I feel it is reasonable to expect these repairs to be completed by August 15, 1988. A reinspection will be made at that time. If you have any questions, please contact me at your convenience. Very truly you s, William Hedges Sr. Env. Health Technician WH /jz cc: BI (T) PA John Karell Enid Carruth SLAYTON ENGINEERING, P.C. Robert A. Slayton, P.E., President Ronald J. Gainer, P.E., Vice President Stanley M. Wilbur, P.E., Vice President .... -April 24, 1989 Mr. John Calbo, Building Inspector Town of Patterson Town Hall Routes 133 & 164 Patterson, NY 12563 RE: Brucculeri Residence 559L Bu le Hole Road Dear Mr. Calbo: 337 Fullerton Avenue P. 0. Box 3228 Newburgh,_New York (914) 562- 3430'y - Branch Offices - 12550 7 Broad Street 1025 Airport Drive P.G. Box 417 P.O. Box 2246 Pawling, NY 12564 S. Burlington, VT 05403 (914) 855 -1255 (802) 864-0226 this letter is offered to confirm the extent of our investigations conducted relative to the above matter, for your information and use. On Friday, March 24, 1989, our office received a complaint from Mr. Brucculeri concerning an unoccupied residence located -a Jace n t'_ to" his_ property„ -11r. -Brucculeri complained of the eroded .condition of the yard and of loose stones 'tha't had rolled off the site and into their yard, which represented a safety hazard. On Friday, March 3i, i989, I made an inspection of this site and met with Mrs. Brucculeri. Mrs. Brucculeri identified where the property line was and where material had eroded onto her property. She also pointed out several large stones (approx. 12 " -18" diameter) that had rolled down from this property onto their own. Mrs. Brucculeri explained that these stones had been used by the contractor to stabilize the slope along the property line, and were subsequently covered with fill. Mrs. Brucculeri indicated that the worst eroded area was in the vicinity of the i septic field for the unoccupied residence. I explained to Mrs. Brucculeri that we were uncertain what, if anything, the Town could do on her behalf and that this might be a matter to be settled by the owner of the adjacent residence and herself. She stated that she realized this and only wanted a representative from the Town to verify her complaint. I indicated that I would �. advise your office of our visit. This concluded my inspection. �1�y 'iar ;•�.3J,'.�r Brucculeri Residence April 24, 1989 ..... _ .. _ _..._._ _ PagfLi 2 Should we have any further involvement we will keep your office informed. Very truly yours, SLAYTON ENGINEERING, P.C. RONALD PERNISI Project Engineer RP:lcg CC: Mike Budzinskl, Putnam Cty. Dept. of Health Patterson Planning Board Mr. & Mrs. Brucculeri Thomas T..Antonecchia,.Esq. 8702rjg.bi .- - . _ _ _.... .:L.P.UTNAM COUNTY DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME � c Orig. Routine ADDRESS Town im No. MAILING ADDRESS P.O. Box Post Office Zip Code Wel PERSON IN CHARGE OR INTERVIEWED Name and Title DATE �9 TYPE FACILITY TIME y /�7 FINDINGS: Orig. Canplain Orig. Request _ Compliance _ Canplaint Comp _ Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain INSPECTOR: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: r. P�JT[VP,M OOiNTY HEALTH DEPARET. �4 f � DIVISION.OF ENVIRONMENTAL HEALTH SERVICES 'John 'M. SiAVbns ". M.D. Derniiv 6mini.ss over of Health ­.FIELD ACTIVITY REPORT - :A U 51 °1 ifi! s`" t •5 `_ t Office Zip Code Name and Title DATE., TYPE FACILITY INSPEc nu TMTMXrrPWn- � .:. 6/86 F^ -: Report. SIGNATURE: TITLE: Sheet Z of Orig. Routine Orig. Complain _ Orig. Request Compliance Complaint Comp Final Group Illness Construction Reinspsction Field, Sampling Only Field Conference. Other d b b 3 w TELEPHONE: Explain PUTNAM COUtITY DEPARTMENT OF HEALTH N0. 436 .COMPLAINT OR SERVICE REQUEST RECORD -DATE - .. :...... -R'1✓F�ERRED-'TO .. Patterson - .7.�.15���:g.. TAKEN BY j A R TELEPHONE CALL_ IN PERSON LETTER CONFIDENTIAL REQUEST FROM M a r i R r u r r u 1 P r i TELEPHONE g 7 g - 4 1 0 5 ADDRESS RR 2 Box 259 L, Rul l Pt Hnl P Rd, PattPrsnn ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST Varant nPw hnnsP- Rain last night- mnrjcli(ia- fiPlriS i t DATE FINDINGS PROBLEM ABATED DATE PERSON NOTIFIED 77 1 ESTIMATED TOTAL MAN HOURS SPENT C zz, 2 _ - j�,/Vyw••U, 4.� PtiTNAM CWNTrY DEPARDMW ( DIVISION, OF MWIRONaWAL HEALTH SERVICES; John M. Simr�ons,' MD, Deputy Cbmmissioner'of Health_ - FIELD ACTIVITY REPORT =Sheet p ^of . SE PDCTION w: -NAME Orig. Routine ��o ADDRESS C)rig. ,Complain &ig, equest ® .� _ _ .-p No- :.Street.- -Town: 2M No.. _ - Complaint Camp MAILING ADDRESS W Final P:o. Box Post Office Zip'Code p.., "Grow .Illness T. Construction - .: =.. nspection`: - pERSpN' iN CiRGE Field, Sampling .Only Cu2;.INTERVIBNED.. :. Field Conference Name,-and, Title {: 00, �. /V FACILITY Other LIATE .i e, : TYPE TIME LEFT �. °Explain - FINDINGS :, c -� -., - - r 4f 0 7777777777-77 27 .P.,t • .. r INSPDCI+QR TELEPHONE: 'Sic ture., and . Ti tle • PERSON °IN t�ARGE Cut` .I1�PI'ERVIEWED; - I _ledge` this °Field Actiq ty Report: SIGNATUREi 6/86. TITLE.: PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME Orig. Routine Orig. Complain ADDRESS Ae) / /-� �G /� N Orig. Request No. Street Municipality ) V)(C) Compliance Complaint Comp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness _ Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Ti Reinspection Field, Sampling Only ,Field Conference / Other DATE �S ` TYPE FACILITY TIME ARRIVED ! ? G /�4,, TIME LEFT Explain FINDINGS: 1 r `..O / —i^ I".° °•; / .vc Xr oa�- -�,r lj O'�Q/ f •�' 1 G / I / �' : �p , Nr 'e- '- / r /.a v , U / /•.o T /-I c• / ? // .,/ / 1 ) " -e7 S % / / �-- car./ a /t" -,6 p Y-- z < — a, cV , ' v i l e P t - e- .5 / Z-5 INSPECTOR: Signature and Tit PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this Field Activity Report .................. TELEPHONE: f SIGNATURE: TITLE _% i ".. .... 2Y�.r1L PIOLmCBaOD 18 Ndmbor of Bedrooms Deeigo Flow G P: D - Separate Sewerage System to conalst of Gallon Sepdc Tank and To be contrasted by " Address Watee,.pl) Pab1ICr Sap Sapply From 'Address orb' P�rlv6to.Sap`ply.Drlllod br _Address 06eir RertId"Ji tents t y i/%` �O `rQ 7� I,reDresent that-:1 sm wholly antl completely responsible for the design and location of the proposed systems) 1) ,that the separate, sewage, disposal system above daSCr,ibed_wrll be. constructed as3h iwn oii :the apProv`eC amendinent.there;.to and �n'sccordance wdh the stanch "rds, -rules an :regu a ions o e ,u nam "• , , - . - Coubty Department of�,Health;�i and -that o'n completion- thereof a "Certficate' -'of , Construchon Compliance" satis}attory.to•the Commissionerbf Healthwill. . be submitted,: to the,,0epartmert, and .'a' wntten,guarsntee will be furnuhetl:fhe ownei, his,' uCCessort, heirs or assigns by,.tfie budder, that said budder will place''`m "good.operating= condition any'part o[ .said sewage_ ditposa1. systisryi ring the peuod'of two (2) years immetliateI following thetlata of ttie. , U, ante Of the approval =pf the Certificate, of .Construction Compliance of-the.ori anal system Orc repairs thereto; 2) that the drill tlefCr ibatl: abOV6 ,will be located as shown :on the approved ".plan and that said well will be�dnst "in' accordance a •standards, let and requ a wns- of the `;Putnam" County Deparment t_ Health . _ - Date. P (�, Signs p, P. R.A. Address. O � "' o License No APPROVED FOR CONSTRUCTION Thii approval.,expues�twoyears from the 'date issued uMass construction of thg�buildinq' has been, undertaken and is revocable for -cause ' or -may. be-amended or modified when "considered .necessary -by the Commissioner, of Health.' Any change Or alteration of construction requires a new permi .��. Approved for, disposal f domessttiicc`sa�ndarryy sewage, and /or - rivets water Supply, only. /1 87 Date�f _YS ' \ . Y BY v m PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIROIMAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CON TRUCTION PERMIT Cc� � � DATE REVI �-� r `` BY: LIC _ ( - of Owner.) ~(Street Location ) - - ,- - ---T-- DOCUMENTS Permit Application Corporate Resolution ,Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Ar-ea;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft: of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same DAVID D BRV.EN,�_._._ z - - County E ecutive • - -- - - "' JOHN SIMMONS. M.D. Deputy Commissioner DEPARTMENT OF HEALTH Division Of Environmental Health Services April 24,1 986 J. Robert Folchetti, P.E. & Associates P.O. Box 297 Brewster, New York 10509 Re: Proposed SSDS's Burdick Glen (T) Patterson Dear Mr. Folchetti: Review of plans and other supporting materials received relative to the above- captioned projects have been completed with comme offered as follows: Lots #7,5 1 1. A corporate resolution.must be filed authorizing the applicant to act on behalf of the corporation. . J2. Two sets -of_ ho.use.- .pl.ans are not provided f3. The number of bedrooms proposed does not appear on the plans A key to the deep hole /percolation hole designations is not provided. 5. Fill section must slope from top to toe 1 :2. Horizontal distance between top and toe for a 4 foot fill section is 8 feet, five foot, 10 feet, etc. Lot #8 1. The extent of the fill top to toe is not shown on the plan drawing. 2. A 1250 gallon septic tank should be provided TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 F4 _ J..Robe:rt- ..Fo�lc;he:tt :i, P:E: &=Ass ci'a'te °s April 24, 1986 3. See comments 1,4 and 5 above Upon receipt of submissions revised to reflect the above comments, these projects will be considered further for approval. J. V4&,Itra1Y. yg41rl, JIhn' Karel I, Jr .1, P. E. D rector, JK :pt Environmental Health Services c c : J K File 3y 1p 2 TO: F E CORDS ACCESS OFFICER -DATI; - Nam_ o i Acenc_r 5--° 10 pcdrass I EFFEE r APPLY TO IN- CT T=- FO_ -LO:•- , NG R COED P.�� =use 4ea `.o�Sl7 FOR USE ONLY Dt.i == D C R'u:TlON OFFICER 4 /L /0 - 89 'g. Recd = 0 w hicla this acenc T Z.S Le-c? CL's -ca-i an Ccn.*IO be fauna. c:3) 1s Ilat AI by t-'---;s Agency 7 Ti L NOT 7 C? YOU HAVE A R:-G----:T TO A?= __.:, F DLV_?L CF TH.-TS A??LICr.'r!ON TO THE Name B.sizess Ac-dress ini 1 ?r�ci FliLL`r E ?L ?'�I E.S F =._5 -"`i5 FG= SuC D =`I7.n IN W=- - *iG SEVEN D =YS Cat- i� �... CD 'gin t Y Recd = 0 w hicla this acenc T Z.S Le-c? CL's -ca-i an Ccn.*IO be fauna. c:3) 1s Ilat AI by t-'---;s Agency 7 Ti L NOT 7 C? YOU HAVE A R:-G----:T TO A?= __.:, F DLV_?L CF TH.-TS A??LICr.'r!ON TO THE Name B.sizess Ac-dress ini 1 ?r�ci FliLL`r E ?L ?'�I E.S F =._5 -"`i5 FG= SuC D =`I7.n IN W=- - *iG SEVEN D =YS Cat- PUTNAM COUNTY DEPARTMENT OF HEALTH 7. - DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date December 21, 1987 Re: Property of Loft Corporation Located at Bullet Hole Road (T) Patterson Section 73 Block 3 Lot 25 Subdivision of Burdick Glen Subdv> Lot # 1 Filed Map # Date Gentlemen: This letter is to authorize J. Robert FolrhAttFy & Associates a duly licensed professional engineer X or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this.matter and to supervise the construction of said system or systems - in. conformity with. theprov_isioris. of_.Art- ale - 145- or 147, Education Law, the Public Health Law,` and the Putnam CountY'Sani- tary Code. Very truly yours, Signed w 0 er of operty Countersigned: 05J.011 k Forbes Pumphouse Road PoE o , RoA. , Address P. O. Box 374 Address - Brewster, New York 10509 (914) 279 -3346 Telephone Brewster, NY 10509 `own 014) 2,79 -8157 Telephone 1,4 c--. . � � L-7-- lt�rel 0 Z 0 APPMIX B PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL ENTAL HEALTH SERVICES INDMDUAL WATER SUPPLY & SUBSURFACE SraP= DISPOSAL SYSTEMS REV=W SiiEET - CONSTRUCTION PERMIT DATE RL.v-ED: BY: �----- --== -= (.`an -e of Owner) (Street LQC3tlon) CC?�` iIS YES N0 1 DCCLMk WS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consist`nt Perc Results Perc Hole Depth 1 lans - Two sets pe_rni t; P.R.- _ Variance Request —�-'— �- I I i I I:E� Lrench provide y required y X 60 ft. MaX. L coy e � e S i ro /l�df FILL SYSTEMS $ � X claybarrier 10 ft. f ill notes ® "-;oW new i� ltours x I v � Y r r�- 100 yr. flood elev. - i X 200 ft. reservoir, etc. Y 150 ft. triQall /call. I -,! I k all t-074-.1 -7,:a-- -5-257 s/s L�vt 5U CN Psrc (3) Fill yf Cd G�4AL Larsal Subdivision Subdivision Approval Chec :cad Ex- acaroval SSDS Adj. Lots Check-a-4 ML._ana own /DEC Permit R & D) .A L� DDS Plans & Permit Same REQU£RED DETAILS ON PLANS Sewage Systen Plan - (north arrow), Sewage Systr -Jn Hv =u1ic Profile - Gravity F1cw Fi ro i imensicns o LLe rencn _e*- ; _ _ _ aetails Septic Tank Sizd, Detail Well Detail, _rice LIEE it over Construction Notes (grinder -rate) Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Locates Representative of primary and ec ansion Expansicm Area; shown; gravity flaw, suff. size If Pmred Pit & D Box Shown & Detailed ouse - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds douse Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 110; Type pipe No Bends; Max. Bends 450 w /clenout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fi1L 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - certain, Leader, Footing 351to catch basin, stormdrain,piced watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 115 Well to PL 9 PUTNAM COUNTY DEPARTMENT OF HEALTH zr- DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SFMT- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.- Owner fICF_L /I N &I TT' '�l DE d Address RhooT V 1 9 Located at (Street �: Jtu-1 �n� �. �h I& o Sec . Block 7J Lot 5 � Incti catee n arc s cross stray Municipality -rpw.0 4 ,?_ATTCRSCW Watershed_ C a oToo SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME. PERCOLATION PERCOLATION Run apse p o Water water ve No, Time From Ground Surface in Inches Soil Rate ,..,Start-Stop Min. Start Stop Drop in Min./in drop ��i`�r^� ^ ✓' Inches Inches Inches l E 2' 18 ?:l7 SQ I'1' 3.1 3C) - Irh 3 d I'7 'lz I V-, z e 9'i 7 _ z - � 4/-o _- _iTF, 5 20 2,L 3..1. -S."i 3 2• s� - 3' 2 S 4 5 2'Iq /?2.s zA Notes: 1) Tests to be repeated at same depth until All data tell equal soil rates are obtained at each percolation test hole. Al for review. 2) .Depth measurements to-be made from top of hole. I L. VqV TEST PIT DATA REQUIRED .TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH-. HOLE.. NO:; . .. .. HOLE ' NO o uHOLE_ NO.. :. n INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES. AFTER BEING ENCOUNTERED / TESTS =MADE IBY G ,_Q�._� Date DESIGN Soil Rate Used 1L - 2 D Min/1 "Drop: s. D. Usable Area P 5000 Or liEw Noe, of Bedrooms Septic Tank Capacity IV 0 0 Absorption Area Provided By X29. LeF.xN _304!_r = - ijd nc'' name •t- Address ?D Sing 74 SEAL _g��wSt`fteC 1.1Y �t�'S�9 �f 06 THIS SPACE FOR USE BY HEALTH DEPARTIENT ONLY: Soil Rate Approved Sq. Ft/Gal. Checked by pate _ - ,';5y`;,`) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVxSION. -..OF ENVIRONMENTAL HEALTH. SIMVICES COUNTY OFFICE BUILDING, CARMEL, 10512 .,'1 �' DE$IGN DATA. SKEET SEPARATE 'SEWAGE `';DISP;OSAL 9YSTEN� FILE NO. Address D Va 1090R, Block :Located at (Street. � � -,Lot /1: /,d, /01 ' ;.:. 'ca e•nea es cross s..ree Munici lit 'io Watershed• Pa T SOIL PERCOLATION=''TEST DATA REQUIRED TO BE- SUBMITTED WITH APPLICATIONS :Number. Cfi3OCK TIME PERCOLATION PERCOhATION apse p o a er Water ve No: Time From,Ground'Surface in:Inches Soil Rate f Start': Stop Drop in Start Stop Min. �, P Min. /in drop , Inches Inches Inches Q. p1 r ' yeti': t 4` .2: . PlBC.oa,e�! DA i Notes. 1) Tests.. to be repeated` at same depth I;until an roximatelyy equal, soil :rates are obtained at each percolation test Yale. All data to be submitted for review. 2) Depth measurements to be made'ro Top of hole. pL M 1 ... • +� C. �' I..:�, f • 1`.a 1 G:) � C�` t. ��-. �,% •i ^•• { c.. ..a n. "Aar F WITR-,:AF T.T MICATION":.. pp TED �IN. TEST -3 HOLES HOLE AO' 'A tr Kvw ft j Ns lj`g i. ll�. jr kq P' SN¢ EE�ESNG S OTjiifir=. rPa Pr ..D UsablL A Cgpacit k d b .,--.Chec e y, it 1 { l ` PUTNAM COUNTY bEPARTMENT OF HEALTH Y/R @V . 3186; ' DIA41ou of Envlronmental'Health Services. Carmel, N.Y. 10511 Engineer to. Provwe Permit # on CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT FOR SEWAGE Permli, N " DISPOSAL-SYSTEM Located at L�(' i. i_ _��(. i. o �� ��. Town or.' Village' Subdivision Name J"i�L5.1'CK C�LEh('T.Sabd. Lot 0_ :'. TA: Map_ �3 Block 3 <..: Lot 6 t Renewer ❑ Revlelon ❑ Owner /Applicant Name_ _ D i? L-20il &1STZLyC.T i i0 t`i Date of Previous. Approval Maftg AddreeeC�10 •MF_LLA1L1 Z.Z" ' 1% Z,O � 1JrTown_ Zip Bullding Type Let Area 44.4 S 9 sq' r Fill O Depth Voldme -741 Number of Bedrooms Design Flow G /P /D PCHD Notification is Required When Fill is completed Separate Sewerage System to con aIlifodooG Lk —_" ri M-t . To be contracted by ( Address 7 Water Supply: Pdbllc Supply From Address or' PrIvati-Supply Drilled bpd Zt ress Y• d ' l tOther 1 , k 612 _ C _E (•represent [haul am wholly and completely, resDOnsitile for'the design and location of tlie; proposed systemts); �1) that the separate. sewage disposbf.�system above described will be constructed as shown on the approvedamendment there: to and imaccordance with the standards, rules an regulations o e ,Putnam County Department of -. Health, and that on completion thereof a "Certificate of Construction Compliance" •satisfactory to the Commissioner of Health will be subm itted. to. the "Department, -and 'a written guarantee -will be furnished. the owner, his successors, hells or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal 'system ,during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance. of the original system or any re irs. thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said. well will bednsta ' in a standards, `les and 'regu aaa om oof the Putnam County Department of _Health. - - Date. 41 Ii j a(fC7. Signed P,E.'�: R.A. - ti Address (7 X C^J' �TC ©�O License No ©S 10 1 APPROVED FOR CONSTRUCTION: This approval expires one year f m the dat issued unless construction of the building has been undertaken and is revoceDle for cau �ror may be amentletl of modified when consid red n essary by a Commissioner 'of - Ith 'Any change or alteration of con truction requires a new p mit. D W� d for disposal of domestic sa i ry swage, and/ r pr a a! r uppl only _. - Date BY Title �� A. M it Lill Ail B NJ VI win ma Ali' Oil 1 MR; "'OK ST Wr via AMA. i _ -. -!- i y =,•�� , I, I•I :I I I i I , L I I i I :i: 1 I' 1 .. , I I • L, i. i I , ' I i I I � ' i ' � I I � '�ja� �'• I 1 1 , I IIli 11' ,I IIIII��� I i I. i ( I I � ,•,I La1 R... �- •1- 'I- -_. .. I_'L;1 � l..i._i i� i .� , t 1. .I. .. 4 I ; 1 ,. ,. , I �I t 1� r i I •I I .I i ;j' 1 U w' ,.i III •,_, ::hl I..�. .,i I�,r���� I I• i I I I i � I III f F;: , ., � i , 1 1 I 1 •. '.4i/ �'�qlt K w 1. - .., {.., � I , I I 1 I I 11 I � I. � I , ,rl (. r ({•N I , ai+l�.tA 1ef 1 1'il .t �{�i�'•Il�ilrlir� I I I ' I I. �11 I f. J• 1 1 I ' I I vra r i 1 1 1 I I : f ' r IJI''J t i i 1 't I � r 1 � , I , ' vra r i 1 1 1 I I : f ' r IJI''J t i i 1 't PUTNAM COUNTY DEPARTMENT OF HEALrn DIVISION.OF ENVIRONMENTAL HEALTH SERVICES 86 - .Re':- Property of Horizon Construction Located at Bullet Hole Road (T) Ea Prson Section 73 Block 3 Lot. 25 Subdivision'.of Burdick Glen Subdv. Lot #. 1 Filed Map # Date Gentlemen: This letter is to authorize J. Robert Folchetti & Associates a duly licensed professional engineer X or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promula.gated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or ' - -°"�147; "Edica "t ion Law; `:the- PubTs Healtlil:,aw;a' and -•the Piz "tnam Courity "Sarii- -�'" � -- " tary.Code. Very truly yours P. O. Box 374 Address Brewster, NY 10509 (914) 279 -3346 Te one r o Property -Hee n- Real-ty.& Development Corp. Rn Avenue Address Brewster, NY 10509 Town (914) 278 -2111 Telephone C74 Z; -F: UTNAM.COUNTY iw 1 �RTMENT OF HEALTH :2.° DA !3 - �. , , ti , ' �+� er, p� v� �..� Rw•.sz,�Q. f, fc.�- ge.,n�r �v Notes 1)'`,Tests.to be repeated at same depth 'until appproximatelyy equal soil :rates are obtained at each percolation test hole. All data to be submitted for. review. 2) Depth measurements to be made. from 'top of hole. �?ce -v- T^.tC NA �;1.I1 4l `07. apse Depth to Water Water Level , ' No'. ;Time From', Ground Surface in Inches Soil Rate Starto top Min. Start Stop Drop in Min. /in drop Inches Inches Inches {•. /{ +nib .fM YNA(. .l� PS•.. 1QAKi4R, ttiYeV! 04a` 1' M1C7i:" JLCR.:•' 6:' f1 'Idi7.'r.'+•C6y'{.'i:I1R"d •r r. :2.° DA !3 - �. , , ti , ' �+� er, p� v� �..� Rw•.sz,�Q. f, fc.�- ge.,n�r �v Notes 1)'`,Tests.to be repeated at same depth 'until appproximatelyy equal soil :rates are obtained at each percolation test hole. All data to be submitted for. review. 2) Depth measurements to be made. from 'top of hole. �?ce -v- T^.tC NA �;1.I1 4l `07. E '.. -45u 3MITTED WITH::APPLTCATION NC 6.TM !E W IN , TEST HOLES HOLE 00. lal te__,, I MIN r jr 2r�F V . • a5 ( 30011j, { rc�r ti, •. ,w g�Ss AFTER `BHEING ENCOUNTERED I Diate -Provided LD.. Usable- Area ... 7"7777 . 'Capacity Cal s,?;, �► e! . .._ Fox2F" 'fig lal te__,, Putnam County Department of flealth Division of Environmental Sanitation AFFIDAVIT - CORPORATE' OWKER APPLAC.ATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for . ____Burdick Glen = l_,Q ,s�� �,_Z3nci$_-- __- _- - -_. -- Ed Heelan__ -_ -- ___- _____ -. represent that I am an officer or employee of the corporation and am authorized to act for _ _ _ _Horizon _Construction_ _ _ _ _ _ - _ - _ _ _ _ (n/a,,m -e) o �c,orporation) having offices at _ _� _E�� _�= HZ -�% Whose officers are President Aol.Mft �C� ! =• _ — 7Name a d Address) 'n , Vice -President.. m (Na e and Address ) Secretary — — — — �DIJ— �'0 7iZA —���/v (Name and Address)_. Treasurer (Name and Address) T and that I am and will be individually responsible for any or a ac of the corporation with respect to the approval requested nd s sequent acts relating thereto. Sworn to before me this 0 day Signed of 19 Title No, ry Public RICHARD I. OOIDSAND Notary Public, State of New York No. 6573920 Qualifie d in Putnam Cty. No. Term Expires lam. 1 9 6dD14-- 31 ' Corporate Seal PUTNAM COUNTY HEALTH DEPARTMENT - ....._ DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of ffm INSPECTION NAME Orig. Routine / Orig. Complain ADDRESS A-47 � ^^ Z ::� 1-7c-Z:2! No. Street Municipality ) VV)(C MAILING ADDRESS / s` 'r� e"' P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Tit DATE_ TYPE FACILITY q `�° �✓ Orig. Request Compliance Complaint Comp Final Group Illness Construction _ Reinspection Field, Sampling Only W�c,fleld Conference Other TIME A RI ED �� Gi�� TIME LEFT /�` /�.-� Explain , FINDINGS: , INSPECTOR: Signature and Tit PERSON IN CHARGE OR INTERVIEWED: TELEPHONE: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: � .: ,. j-; �- _- - �" DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL ��✓ PCHD PERMIT # WELL LOCATION Street Address &Li.i5t ie Rb Town /Village /City Tax Grid Number PATMQ. ti NY 79-3- 25 WELL OWNER Name ,3&8k -o(c -- Address ®Private 0 Public USE OF WELL 1'- primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O BUSINESS O FARM ❑ TEST /OBSERVATION ❑ INDUSTRIAL 0 INSTITUTIONAL O STAND -BY ❑ ABANDONED ❑ OTHER (specify] O AMOUNT OF USE YIELD SOUGHT j gpm /# PEOPLE SERVED /EST. OF DAILY USAGE (p 00 gal REASON FOR DRILLING ®.NEW SUPPLY ❑REPLACE EXISTING ❑PROVIDE ADDITIONAL SUPPLY SUPPLY 0DEEPEN EXISTING WELL ❑TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED ®DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION :f3 u l =_IL 6 LGCJ Lot No. 6 WATER WELL CONTRACTOR: Name If Em2i' T?ga, V D Address: "z- 6-ofyZi- l5L IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: , YES __�4_NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION /'z-A467 ON REAR OF THIS APPLICATION (date) PERMIT TOWN /VIL /CITY 8ON /]SEP sipA,ature 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. Date of Issue: // 19� Date of Expiration: 19 %� ermit Issuing f icial Permit is Non - Transferrable