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HomeMy WebLinkAbout1680DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -3 -19 BOX 15 lirs �%-- f-ii r IL ;r - 1 .:1 Rev 31 M PUTNAM COUNTY DEPARTMEXT OF'HEALTH '6 Division of Environmental Health Ser'Am, Carmel, N.Y., 10512 Engineer Mzist Provide P- 20 z?S- P.C.H.D.. Permit NE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISP �mt Name fe3 ;AL SYSTEM PCAeCS0V1) To. Map Block— I't l M_ S ubdv. Lot # Subdivision Name U y Date Permit issued dz qI-elds er AN ;1-11nge Systim, billt by da I I Ir -<y <�*� Address :2n/ V la Consisting of /,ZS-O ___Gallon Septic Tank and Water Supply: Public Supply From Address x — Private , Spply Drilled by Hit 1, a,1_smr.Ad&,, Rrew&Aswr My on' Of. Bonding Type ---Has Erosion Control Been Completed? Yes Number of Bedrooms Hrs Garbage Grinder Been Installed? Otber Requirements I certify that the systemcs) as listed serving the above premises were conptri4cted essentially as shown on a plans of the completed work copies a of which are attached), and in'accordance with the standards, rul6s and reqp*tions, in accordance with th it plan, and the permit issued by the Putnam County Department e,6f Ifealth. P.E. R.A. Date 97 0y_'V W I I 6rod6e, 69-f rae r, 1 -1 License NO. 4 Addre - "t V Any person occupying promises, served by the above system(O Shall prompti ak,.o such action as may be necessary to secure the correction of any unsanitary conditions resulting 0qm Such U111690. Approval of the sepsrite'sswirs i SO' am shall become hull and void as soon as a pub(;: unitary Sower becomes aw available grid the j60ro4jl'6f _ the Orivite water Supply Shall become ' nul a when a p becomes available. Such approvals are Subject to m9difftation fir change when, In the judgment of the "IN r of Healt h costa or change is nequery. T. *Date BY TI tie 04 -18-1997 08 :31A 1 WELL COMPLUTION REPORT :h DEPARTMEEN"' OF HEALTH Division Of Envirottuanta! ueFa1ii7 ilex r iCcS PUTPAM COUNTY DEPARTMENT OF HEALTH FROM MILL DRIL LINE TOq 2702558 P.02 i Office Use Only STUET ADDRESS: 1uwM1YK.LA41uw1T TAx GR10 NIJAINfr� WELL LOCATION big ELI* ltd. a Patteraong NY, KAME' ADORES& PRIVATE WELL OWNER JQ6 controotinge PO Box 531, Curmv -t a. �;/ p PtlBL(C USE OF WELL PRESIDENTIAL O PUBLIC SUPPLY © AIR /COND. /HEAT PUMP O ABANDONED 9 - primary. 0 BUSINESS 0 FARNI E1 TEST /OBSERVATION 0 OTHER (specify) 2- secondary 1 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY 0 MOUNT OF USE XIELD SOUGHT - gptn.lNO. PEOPLE SERVED J EST OF DAILY USAGE gal REASON FOR DRIWNG' DEPTH DATA DRILLING EQUIPMENT WELL TYPE '.. CASING DETAILS SEREEN REPLACE tXISTING SUPP:"Y TEST /OBSERVATION [3ADDITIONAL SUPPLY ONEW SUPPLY (NEW DWELL:LNG) 0 DEEPEN EXISTING WELL _ WELL DEPTH 305 fl. STATIC WATEA LEVEL Y0 ft. PATE MEASIMEp 41 9< ® ROTARY COMPRESSED Alfa PERCUSSION ❑ DUG O WELL POINT 0 CABLE PERCUSSION 0 OTHER (specify): 0 SCREENED O OPEN EI40 CASING TOTAL LENGTH — " LENGTH BELOW GRADE 30 DIAMETER n 6 WEIGHT PER FOOT - 19 DIAMETER (in) �SLOT SIZE DETAILS "Rs" SECOND GRAVEL PACK "YES GRAVEL, E3 NO SIM. WELL YIELD TEST It detailed pumping ME(N00: 0 PUMPED 1 tests were done Is in- )aCCOMPRESSED AIR ;'ormatian attached? 0 BAILED ❑ OTHER :OYES ONO WELL DEPTH DURATION DRAWDOWN YIELD ft. hr. Thin. ft. 9cm. WATER `tMEAR TEAM, QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? tIES ONO ANAMIS ATTACHEDM YES ONO PUMP INFORMATION TYPE m CAPACITY _ MAW DERH VOLTAt,F H¢__. = OPEN HOLE IN BEDROCK 0 OTHER .� tL MATERIALS: STEEL ❑ PLASTIC 0 OTHER tL JOINTS: © WELDED M THREADED 0 OTHER — In_ SEAL:BcEMENT GAOUT O BENTONITE 130THER 1b. /ft. DRIVE SHOE O YES 0 NO I LINER:0 YES O NO LENGTH (It) DEPTH To SCAEr--N (it) DEVELOPE07 o TES ONO I DIAMETER . I Bonom OF PACX - T iR. FYM _ fL DEPT?{ . WELL�� ��� II more detailed lormallon descriptions or Sieve anal) are available, please attach. CE'T14 Ff am Water Well SURFACE Bear. Dia- FORMATION DESCRIPTION ft. ino Meter s=v�-Iasce 10 Sand & cobbYisa- a. Yl _ Me'c ium to hard �irsanate ;;A aa- m -0 hard 6giii z a'. ft. L3 8 01 alit R STORAGE TAN X: : TYPE P0- t �t.9 rr CAPACITY WEu.tl ULMNAME tIL,L L &I),I_ZINC,v o /46/y0 Amsm Putnam Avenue Lvew,stern 14.11" I; 04 -16 -1997 04 :03P(l FROM TqRL.TOH LHZ-- TO 19142795'075 P.02 -'_ NoRT EASZ` �• ORATORY OF' DANBURY . I11YC. L9L Lop- 4m?R� ?, - - 39 -3 MIL ` PLAIN ROAn - :v *,.►irIrk, CT 06811 CT Cert. PH -0404 F: ( 03) 74$ =791)3 -. FAQ (210.3) 18- li' t52 NY Cert: 11471 d I 2121 , !r LAI3 6RATOVREPOW.I., a.r ` . :xkTER UPPLY TESTING h�IIT~L D . Y 'II�1�y INC ; . j -L E' COLLECTED: _ 4/11197 p NANIXM- WE i liv1E COLLECTED: 11:45 A.M. BREWSTER,! 1.x...10509 C01L1;CTED BY: RUSS E JREt"EY ''ED cw LAB: 4/11/97 I DR TE(S) TESTED: 4/11/97 T BY L AB# 11471 ESTED I REPORT DATE: 4116/97 k k SAMPL E Sl M . AMOS KOACH. 'BIG I:I M ROAD1 PA;TTERSON, N.Y. k., ..' P . INT: NOT STATED . WELL, �, : TR I T: , :�• %TEft SOFTENER aI .. TEST PEREURMED_ ..__ .. REST: L i .RE.COMNIENDED -LINnT ..... . . AL: ..BAC of colifonn (B ctexia) -100 ml 0 per 100 ml r HEMCSTY2'i: ..�. j R . Chlorine R eWual. Nu LlIgIL - - - -- ;' ml ��mt1W;�ter � • �1$R. ° IDl�l 5 � LIt@7 � nong. d isQiCd RESULT sI ASED.ON SAMPLES SUBAUTTED:4 /11/97 SAMFLE� 'VESTED OVE: [DIP ti 1. 31,E Or qOT POTABLE (PER STATE bF NEW YORK DE . OF HEALTH: SERVICES.' l -JQ)AADS, r0ft POTABLE WATER) I. ., � ; ��rat Director • NORT7MA ST LABORATORY, 129 NML ST2Et f 101 t. CT 06037e (860) 828 -9781 - F.4X (860),829-1050 TOLL!OIREL WITMN Cl. 3;04-6-t, - 's OUTUDE CT: 800 -634 -1230 l PUn\IA.t•1 Cb:JNTX DEE-PPOM/ia I OF 'HEALIi1 D SIOIN OF E1VJ20jITAL AF LTH SERVICES Building Constructed by S/ ci EIS Loca en - Street rSM,Cirality Build33ng TYce Wa /Aed- 1, b� Subdivision tea Subdivision Lot GU R.?R—LEEP OF SUBSURFACE SE�,&-?-ILF DISPOS..r SYSTE -M I represent that I an wholly and co:npletely responsible for the location, ��pr riC,�chjD, m teraal, construction and drainage of the sewage disposal system, serving the above descries property, apd. that it has -been constructed as shown on the approved plan or approved amendment. theretoi and -.'in accordance with the standards , rules and regulations of the :Putna.M, County Departarent of Health, and ,hereby cuaiantee to U ne cr, ner, his successors, heirs or assigns, to place in go&d operating condition any part of said system constructed by me which fails to operate for a period of two years i.—r;:ediately following the ca.te of approval of the "Certificate of Construction. Compliance" for the sewage disposal system? or any repairs :ace„ { :such_ s-_ - p,_excepl- where. Vie. failure.:fo,n. pf ate. pr.:oper_ly .i.S caused by the willfuI or negligent act of the occvpant.of the building utilizing the system. , The undersigned further agrees to accept as conclusive the deteiaaination of the Dixector of the Division of Eziv ror -Ental Health Services of the Putnara County Department o-I Health as to vhether or not. the failure of the system to operate was caused by the willful or negligent act or the occupant of the building utilizing the system. /I . I/ Date this 9 day of ri l 19 9 `7 G-e-nera? Contractor (Cre,ne_--) - Si gnature Corporation t�a,-, e ( f Corp.) .P- duress rev_ 9 /&S MIC Sicnature Titled .7 5�� , l lAL=ra_tSys Nc r Corp.) -rVy I; 11 R®Gd Pr �w der A%. Y, /O=50 i F es s 1.9 O�rner or Purchaser of Euilding Section Block Lot Building Constructed by S/ ci EIS Loca en - Street rSM,Cirality Build33ng TYce Wa /Aed- 1, b� Subdivision tea Subdivision Lot GU R.?R—LEEP OF SUBSURFACE SE�,&-?-ILF DISPOS..r SYSTE -M I represent that I an wholly and co:npletely responsible for the location, ��pr riC,�chjD, m teraal, construction and drainage of the sewage disposal system, serving the above descries property, apd. that it has -been constructed as shown on the approved plan or approved amendment. theretoi and -.'in accordance with the standards , rules and regulations of the :Putna.M, County Departarent of Health, and ,hereby cuaiantee to U ne cr, ner, his successors, heirs or assigns, to place in go&d operating condition any part of said system constructed by me which fails to operate for a period of two years i.—r;:ediately following the ca.te of approval of the "Certificate of Construction. Compliance" for the sewage disposal system? or any repairs :ace„ { :such_ s-_ - p,_excepl- where. Vie. failure.:fo,n. pf ate. pr.:oper_ly .i.S caused by the willfuI or negligent act of the occvpant.of the building utilizing the system. , The undersigned further agrees to accept as conclusive the deteiaaination of the Dixector of the Division of Eziv ror -Ental Health Services of the Putnara County Department o-I Health as to vhether or not. the failure of the system to operate was caused by the willful or negligent act or the occupant of the building utilizing the system. /I . I/ Date this 9 day of ri l 19 9 `7 G-e-nera? Contractor (Cre,ne_--) - Si gnature Corporation t�a,-, e ( f Corp.) .P- duress rev_ 9 /&S MIC Sicnature Titled .7 5�� , l lAL=ra_tSys Nc r Corp.) -rVy I; 11 R®Gd Pr �w der A%. Y, /O=50 i F es s APPENDIX B. , New York City � Environmental Protection APPLICATION TO CONSTRUCT A SEWAGE TREATMENT SYSTEM ON NEW YORK CITY WATERSHED Your building site is located within the Watershed of the New York City Water Supply. Under New York State Public Health Law, the design and construction of all sewage disposal systems constructed in this watershed must be approved by this Department. The inspection, review and approval performed by this Department is independent of that performed by any other agency. Please complete the following information and*return this sheet to the above address. Your or your authorized representative will be contacted to schedule a time to perform a site evaluation. Owner's Name: Current Address: Daytime Phone: Contact Person: Ile "y W. /V, Phone: Z78-K-iof3 PROPERTY LOCATION Town: ,rs Village or, Hamlet: Street Address of Site:'i� F1�� Subdivision Name & Lot #: Tax Map Number: Number of Bedrooms: Property Owner's Signature: V Date: Acreage of Lot: 54 June,1993 T; vex DedIp Flow G - rim SMQEW: 7011 ' kEft d So@- 1l�!/��SOr� >ti %rep -ic r 1r 134�7 WaN Oft e �, ,r iii • � r�r 1 r.p►eNnQ'Yhat 1 am aiholly seed compla4ely vesponsiBle90c thedesighand, location of.th© pvopowd syst ®m(s); ]) that tho siiparato saws o;dis oral s item aliov® dwer will b®,00nserue4ed as shown on the approyeaa amendinont thee®_ to and in aeeo'®anpe with the standards, rules on rogu. _ ns,o o hem County �opoetm®nt ;OQ MeeiQh; ;and that on completion,th®veof a'•CVcM�ficat ®; of'Cons4vuction Compliance" satisfacI Or ry tO the COmTisfloner at MOalthwill BID 'amBmBte�` to the `®Oparthis9eit ®nd,;a, ;written .guarae4eo will w :4urnisho0 the owner, his elf ee Vf. heirs a assigns BY the Buil9av, that acid bYiQOM will place ih ®OOastiei0 OOnOttlon any Per ro ' "ids we" disposal system +during'.the pages o4 we (8) yams immediately folcowinv tpoilito 04 the IM- ..St of 4Ata, opp7oval of @Ae :C®rti4ka4 ®,;of Coristvudioo� ComplIanC o4 the, original- em ov any Pap thereto; 2) that the drilled wolf dese.�d show wIN;81e loe®4 as deaeVw on tRO'9prove®,pbn and.;tAti4 s�6d fell will De inst`1' in `atcoeda A tNe �s and r¢8u nor of the t►u @norm Q;ounty ®®p®Ptm®P64.04 PlealtA. -. , h7&Ite. 1@ Sqn� 0►.E. A. 6 (2 j AddP®ffi ° I License No 4A6 PRONCO FCIR COiVSTikUeTl6H Yhis approval, 611"as two years`fvom the -dote iuuod. unless .con$hvueQion of the building has Qwen, and QaOc®n and is P®vocatil®.for cause or may Do amended or modivi� erhen.eonsid6ie6:n®cessary' ®y the, Commission©r of HwIth. Any ehanvo or - alteration Of construction PQuires a near permit., AMOVed fOr' dig poaal`'of domeslk ash ev 01te) �P e'. %C�'95� any us DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 ...� . ».,. <, .- .....�,APP�LICA'!'I ON __T.O.. � CQbi�T.RU�T•. ,P.-..WATER �.kIEIpL ,::.: _.,:- ::,.;-�.. -.:� .<: ,--, A„ � _ . . . PCHD PERMIT WELL LOCATION Street Address r, e_ Village City Tax Grid Number r� i WELL OWNER Name �, Mailing Address �; �/ 2SC> 03Private D Public USE OF WELL 0 - primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT �$' gpm /# 0 REPLACE EXISTING SUPPLY '9 NEW SUPPLY NEW DWELLING PEOPLE SERVED IV-S /EST. OF DAILY USAGE �00 gal O TEST /OBSERVATION 12- ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN aDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A111- Lot No . ' WATER WELL CONTRACTOR: Name 'Tip Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: LIA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM.NEAREST WATER MAIN:._ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED I1- J ®ON SEPARATE SHEET % "p� (date) � fgnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well. in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise conta inate surface or groundwater. Date of Issue: 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 j RANDOLPH W. LAURENT, P.E. j HARRY W. NICHOLS JR., P.E. November 6, 1995 N.Y.C.D.E.P. 465 Columbus Avenue Valhalla, NY 10595 ATT: Margaret Lloyd RE: Proposed SSDS Big Elm Road Patterson, N.Y. Dear Peggy: Enclosed are the following: i LAURENT ENGINEERING ASSOCIATES, P.C. '"': h11ELBF2001EE OFFIGECEti7'RE � , '"':"` . - "" Route 22 & Milltown Road Brewster. New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS 1. "Application to Construct a Sewage Treatment System on a New York City Watershed ", dated 8- 15 -95. 2. Three (3) prints of Drawing SS -1 "Proposed SSDS ", dated 11 -3 -95. 3. "Design Data Sheet ". . -A "SSanitary Const~uction Repoi ", dated 11 =6 -95. If you have any questions, or should you require additional information, please contact us. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. u), Lnce"AC56 Harry W. Nichols, Jr., P.E. HWN:bd 95040 enc. cc: Mr. A. Noach SANITAR*CONSTRUCTIOP REPORT T-O BE COMPLETED BY APPLICANT AFTER DEPARTMENT SITE VISIT Ncw Ynrk Oty ►r Department nf *rEnvironmental Protection wner's Name tunrcipality. PirSa:., County RIA1ia so, - operty Location: ibdivision: Lot: ate Subdivision Filed: Ic Number: a. Bedrooms:_ :recce of Lot: SEQRA Review Required: .tc SEQRA Rcv :ew Completed: :me of Design Pro fessional:o;✓r,, /i 4,47 fir. P ]dress: Cti.r ar „e�i✓ii�a /�(ssoc, _ /4G. 4,'11brd000 (ii iLG Ceh AYe /?/ 2 + NIllew,7 Rd ere A/ /45 o 9, :one of Builder: TAIQ !dress: System No. Date Soils Report # Tax Maps# Building Permit# SPDES Permit# PROPOSED SEWAGE DISPOSAL SYSTEM ' Type System: . �soy� 4'oh ' rei-7 - ,_,!� —, rz w4_ Flow Rate: Ground Slope: % Depth to Groundwater.or Impervious Layer ;;'71 Stabilized percolation rates: #1 Hole Depth ?O ins. Rate 1 in./ 7 7 mill. #2 Hole Depth 3c7 ' ins. Rate 1 in./ S,3 min. DESIGN DETAILS Depth of trench inches Width of trench 2y .. inches......, _ linear feet of y inch perforated pipe inches of slope -per foot G inches of crushed stone or washed gravel below die 2- inches of crushed stone or washed grnvcl above die OW R /RL-P SIGNATURL Y DATE THIS AREA FOR NYCDEP USE ONLY ncLtions of Approval: 1. Watershed Inspector to he notified prior to Mart of construction. e NYCDEP grants approval or acceptance for,the )ve described sewage disposal design in accordance h the above Condition of Approval & with NYSDOH auiremcnts. Any deviations require approval writing from NYCDEP. Project Construction st begin within two (2) years of Approval date. Design Approved: Design Accepted: Date Name Title - Construction Approved: Date Name Title 58 April, 1994 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & MilRawn Road Brewster, New York 10509 CONSULTING SITE ENGINEERS / uC ♦ A'A Gentlemen: We enclose ( ) copies of: O B/W Prints 0 Reproducibles O Specifications O Memorandum Date: Job No.: Project: P12oP. SSt�S 0 t & r-,L I ZOA n row N Or- pA- 7�Ie-�A Reports ❑ Tracings Q Copy of Letter Description: tqi�, wTs sS- I " peaPos r:::b Ssy5 - LOT I 0 6A N aN Ft✓9►� it II D� (b 010-1 OP S oe) M 1ss10 1-0 .G EF f7. 0 Revision /Date No. 11 I It Sent Via: ,Our Messenger p Blueprinter O First Class Mail O Special Delivery ❑ Your Messenger ❑ Hand Delivery O Copy to: Very truly yours, LAURENT ENGINEERING ASSOCIATES,P.C. Per: 2nd Floor 'T wo Story 32x* 66 2505 Square Feet p"Tmv-�,T rnlfiff'L' DEPPI`KiL' T ni 7 ;3-E,DIIW 'I 7*: O 2 1/2 OATH &W"AS7 Ox KtT"M t�oky 00" zoo- SN 43o- 0 T.0 23' -0' x23' -0' rata Garage & laundry room by builder. 1st Floor 2nd Floor 'T wo Story 32x* 66 2505 Square Feet p"Tmv-�,T rnlfiff'L' DEPPI`KiL' T ni 7 ;3-E,DIIW 'I - PuTNAM CAUNrY DEPARTm�Nr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN ' DATA .SHEET- SUBSUFACE SEWAGE Owner „/fH?os /iioa�. Address 's_ a� �� s�¢�C'fSOn /VY Located at (Street) ei� /rte . �(c� Sec. �. `. Block _� Lot 1 Undiccfte.nearest cross street) Municipality Watershed Ceo, -n,,, SOIL PERCOLATION TEST DATA -REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking /v -Zy- js Date of Percolation Test /U �s- r 2 oi; 3y- /D Dil :23 HOLE 2.y 3^ _ 7.7- 3 /o ai , /0;2.x/ •23.._._ NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water-Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. = -Start Stop Drop In Min /In Drop Inches Inches Inches 5 1 11 3 NOTES: 1: Tests ..to .'be repeated at same depth .until..approximately..equal -soil :rates are.obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. r 2 oi; 3y- /D Dil :23 2/'.' 2.y 3^ _ 7.7- 3 /o ai , /0;2.x/ •23.._._ 2�.._...... ..__ ...._:�� /.... _ 3 . �. 5 1 11 3 NOTES: 1: Tests ..to .'be repeated at same depth .until..approximately..equal -soil :rates are.obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. 2 :9 �.3g - mss - /G. Zo% " ZS.7.:; � - ....._...- ...�;;._..... ...._; .....5..3 :. 4 /4 -/S -10:3 3 �� Zl �� Z 5 1 11 3 NOTES: 1: Tests ..to .'be repeated at same depth .until..approximately..equal -soil :rates are.obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS MMUNTERED IN TEST HOLES . DEPTH HOLE NO. �_ . HOLE NO. .. HOLE .NO......__ - - 1 G.L.... w.. z. f -j 1 7 o�so,'l T� ,oso,•� - - • 2' 3' 6' 7' . 8' 9' 10' 14' _ INDICATE 1Z.7EL AT WHiCH • GROTWC�°+ATER •,iS MY CWi-TEREU INDICATE LEVEL TO WHICH 4TATER LEVEL RISES AFTER BEING ENCOUNTER DEEP HOLE OBSERVATIONS MADE BY Ve L,,, sn., -1 46 yl L /o, DATE: Z Soil Rate Used g= /O Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /DSO gals: Type Gc.2-c, Absorption Area Provided By L.F. x 24" width trench _ Other k k �� Y1 O Name LgURENT�N�i1 /YEF�P /NG/jSsoc /ATBSPe- SlgnatUie Address /�/ / /GBROOKC nL6 /CE t� < -N >RF SL +' ; ZZ �/y/ /�4 ro ern /.din. BR,� /5.7 P A, ref soy `�� No. 5612�i THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES'.: Date Re: Property of Aldo,,-, Located at iG �a i11-i'40 (T) ��rT:!!,v Section ,�$. Block .� Lot 42 _ Subdivision of Subdv. Lot # Filed Map #. Date Gentlemen: This letter is to authorize 17i416fY tv, Z.i .P 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 Department" of Health;- 'arid 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. Countersign P.E., R.A., # Address NEB/ CO Very truly yours, Signed �Iv Owner of Property Telephone Address Town Telephone RANDOLPH W. LAURENT, P.E HARRY W. NICHOLS JR., P.E. November 6, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm Road Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. AILLBRQOKE OFFICE CrNTRF.::_....., _.�_,' • . = .- . .� .:. Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing SS -1 "Proposed SSDS -Lot V, dated 11 -3 -95. 2. "Application For Approval of Plans For A Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 11 -3 -95. 4, "Application to Construct a Water Well", dated 11 -3 -95. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 10- 21 -95. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Money order in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:bd 95040 enc. cc: Mr. A. Noach w /enc. ,u - «= - AP! }LIGATIOht EWATER ,DISPOSAL SYSTEM FOR, -APPROVAL.,QF,_P:LAVS, FQR. A NAS7 .. . <1 . Name and Address of Applicant:��as I 2. Name of Project: pp- o/oc"s ,-;1 5S`��S 4. Project Engineer: r-- M. 3.,_• Location Owe: 5. Address: Millbrooke Office Centrt Brewster, NY 10509 License Number: Phone: (914) 278 -6105 Type of Project:- Private /Residential Food.Service Commercial , Apartments Institutional Hobile Home Park Office Building Realty Subdivision Other (specify) V. Is this project subject'to IState Environmental Quality Review (SEQR)? Tie Status (Check One) Type I.. Exempt Type II. Unlisted._ 8. Is a Draft Environmental Impact Statement (DEIS) required? ...........:.. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... A1,1,4 10. Name of Lead Agency 11. Is this project in -an area under-'-the control not -local planning.; zoning, or other officials, ordinances? ............ ...... ....•.•. 2 . ' If so have plans. been .submitted to such : authorA ti es ?. ....... ........... .S T Q.- Has preliminary approval beep 'granted by such authorities? 444, Date Granted: kh 14. Type of Sewage Disposal: System Discharge...... _-Surface dater A- Ground Waters 15. If surface water discharge, what is the stream class designation ?........ AIA I :6 Waters index number (surface) ....... ............................... .. . M� _ i Is project located near a public water supply system? &/A- 8 . If yes, nave or water supply Distance to water supply -- 9: Is project site near a public sewage collection or disposal system ?..... '0 Name of sewage system itlf Distance* to sewage system A/ 1. Date observed: 23. Name of Health Inspector: iw�'Y• ;�rtda,,., ����— 6ko �. Project design flow (gallons per day) ..................... ............... . 25. Is State Pollutant Discharge Elimination: System (SPDES) Permit required ?.. NI) 26. Has SPDES Appl icatiori been sub;7itted to '-local` DEC Offices -.. ...... 27. Is any portion of this project located within a designated Town or State wetland ? .................... ........... ............................... A, 23. Wetland ID Number .................. ..... ............................... 29. -Is Wetland Permit. - required?' .......................... ..................... Has application been made to Town or Local DEC Office ?. ...............`... All 30. Does project require a DEC Stream Disturbance Permit? ................... Alg, 31. Is or was project site used for agricultural activity involving: application of pesticide$ to orchards,- or other crops., solid or hazardous waste disposal, landfilling, sludge application or industrial activity? YES'or NO 32. Is project located-within 1;000•feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ............ .YES or N0 DESCRIBE: 33. Is there a local master plan or file: with the Town or Village? A//. 34. Are com=munity water, sewer facilities planned to be developed within 15 years? �b 35. Are any' sewage. disposal areas in excess of 15ro slope? ........................ 36. Tax:Hap ID Number ......................... ............................... 37. Approved Plans are'to''be: returned to: .................. Applicant k Engineer If the application'is signed by a person ocher than the 8pplicant shown in Item.1, the. 2pplication must be - accompanied by-a Letter of Authorization: Failure to comply with this provision may, be grounds for the rejection °of any submission. I hereby affirm, un.d_er Pena 1 ty of perjury.- that inforn, ation provided on this form is true to the best of my. 1<now7ebge and be 1 ief. Fa Ise sta'te.—,ents made herein are punishable as a Class A Hisde,-,eanor p suant to Section 210.45 of the Pena T Lair. a >IGNATURES & OFFICIAL TITLES: 'AI.LING ADDRESS: Millb -eooke Office Centr Brewster, NY 10509 F_ - BRUCE R. - TOLEY Acting Public. Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York .10509 Tel. (914) 278-6130 Fax (914) 278-7921 vlay 19, 1997 Harry Nichols Laurent Engineering Millbrook Office Center Route 22 & Milltown Road Brewster, NY10509 Re: Proposed Compliance Noach Big Elm Road (T) Patterson Dear Mr. Nichols: 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: There is no record of any as -built inspection being requested or completed by a representative of this Department. - Upon reePipt.of a.submission, revised to r-.flect the above, ihis'application will be co:isidered further. V yours, xj� Robert Morris, P. E. Public Health Engineer RWjp HARRY W. NICHOLS JR., P.E April 29, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 LAURENT ENGINEERING ASSOCIATES, P.C. .; , MI .LLBfjQOKEfJFFICE.GEN.T „RE-;.. "..,c \ Route 22 & Milltown Road Brewster, New York 10509 / (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS RE: Individual SSDS Compliance Big Elm Road Town of Patterson, New York Dear Robert: Enclosed are the following: 1. Four (4) prints of Drawing AS -1 "As -Built Plan ", dated 3- 28 -97. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 4- 19 -97. 3. . 3 Copies of "Guarantee of Subsurface Sewage Disposal System ", dated 4- 19 -97. 4. Well Completion and Well Log Report, dated 10- 26 -96. 5. Water Analysis Report, dated 4- 16 -97. 6. Bank Check in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nich Is. Jr.. P.E. HWN:RL:bd 95040 cc: A. Noach AS -BIALT D 1MENS 10N CHART PARCEL PLAN SCALE: /" = 120' A B C D 54.0 820 N 35',28'16"-' W. 91' 2 60.25 870 .3 6,4.25' 89.0 4 69.5' 92.5' 5 74.5' 95.5' N 6,7° 58'/5" W /57.08' 6 5325 63.0' 7 47.25 N 03' 11'03'E 58.25 8 41. 5' 81.42' 53.25 5O 9 35.25 48.25 N 05 °48' 45•E 10 28.5• O 43.0' 20.88' /I 61.0, 1V 13' 15.44`E 32.49' 76.0• 12 56,.5' 78.57' 70.0' 13 27239' 34.6 45.0' 14 12 28.0 -%.5' 15 13 S /0' 08'32" N 24.0' 4,G 0' l�0 2(n.75 52.5' 15 PARCEL PLAN SCALE: /" = 120' A/0 7E: HOU5E LOCARON 9.4 5E0 ON ' 5URVEY OF PROPERTY' PREPARED SY DEVINE SURVEYING - DONALD M. SOLOMON PL5 N°' 5025(o , DATED MARCH /9, 1997. 10 N 35',28'16"-' W. 91' 20 N 6,7° 58'/5" W /57.08' 3O N 03' 11'03'E 1 /2.34 ® N 0' 13'24"W 81.42' 5O N 14' 42.52 "E 51.67' © N 05 °48' 45•E 185.91' O N47 °45.40•E 20.88' ® 1V 13' 15.44`E 32.49' 9 5 83' 23' 18 "E 78.57' t0 S69'12'46 E 27239' I I N84° 58.06 "E 49.78'. 12 S53 °07'16 "W 6.35' 13 S /0' 08'32" N 104.98 14 512'02'04•W /5.8' 15 S02 °15'58`W 47.57' 16 SOS' 56,' 04 W 53.24• 17 504'06 54"W 87.65' 18 504'/853 "W /37.78' TH15 IS TO CERTIFY THAT THE SEWAGE DISPOSAL 19 A/ 89'25'00C 73.94• SYSTEM WAS CONSTRUGTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER . THE SYSTEM WAS CONSTIZXTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH ,. A/0 7E: HOU5E LOCARON 9.4 5E0 ON ' 5URVEY OF PROPERTY' PREPARED SY DEVINE SURVEYING - DONALD M. SOLOMON PL5 N°' 5025(o , DATED MARCH /9, 1997. f !9 Putnam Counter Department of Health Dieieion of Environmental_ Health Services Approved as n6ted for oon.formance with ePp gable and Regulations of the nam J4"y health Department ..