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HomeMy WebLinkAbout1912DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.22 -1 -49 BOX 17 vim I IN r Is No I We No No No a me + i. al � , LA i 4' l F' , 1 , 6 Mira �, , o 01912 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT e Batavia Road 1 T& ilt'* Patterson, NY lTax ri L Ma4jBlock 1 Lot(s) jV --- * W ell Owner: Name: Donald Mill Address: E. Branch Rd., Patterson, NY Use of Well: 1-primary 2-secondary xx Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional ial Standby Drilling Equipment Rotary Cable percussion XX Compressed air percussion _ Other (specify) Well type Screened _ Open end casing XX Open hole in bedrock Other Casing Details Total length 42 ft. Length below grade _4._ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: Xx -Steel —Plastic---- Other Joints: — WeldedXX Threaded Other Seal: xx'Cement grout Bentonite Other Drive shoe: —Yes No ILiner: 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 7T Yield _ gpm Depth Data . . Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet I Well Log If more detailed information descriptions or sieve analyses ..y are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 15 Silt, sand, cobbles & boulders 15 24 Soft fractured bedrock 24--- - .225- Hard grey.k bl.ac.k. g.ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information 225 7 Pump Type Capacity Depth _ Model Voltage _ HP Tank Type ume _N Date Well Completed 4/24/97 Putnam County Certification No. jDate 3 of Report < 12/1.8/97 We11 D ai�gna i NUTE: Exact location of well with distances to at least two permanent landmarks ided on a�WgttLsheet/plan. 7"v Well Driller's Nampl/- _M - kIPR IL, Address: PUTNAM AVE RREWSTER, -NY Signature: Date: 1-2/18/97 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 . NORTHEAST LABORATORY OF DANBURY (Formerly Tarlton Environmental Laboratory). CT Cert.- pH -0404 39 -3 MILL PLAIN. ROAD - DANBURY, CT 06811 NY Cert: 11471 "(203) 748 -7903 --FAX (203) 748 -0652` _ LABORATORY REPORT me WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. PUTNAM AVENUE BREWSTER, N.Y. 10509 DATE SAMPLE. COLLECTED: 12/18/97 TIME COLLECTED: 4:20 P.M. COLLECTED BY: BOB DATE RECEIVED @ LAB: 12/18/97 DATE(S) TESTED: 12/18/97 TESTED BY: LAB #11471 REPORT DATE: 12/22/97 SAMPLE SITE: DONALD MILL, LOT #2, BATAVIA, PUTNAM LAKE, PATTERSON, N.Y. SAMPLING POINT: - TOP OF WELL SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: RECOMMENDED LIMIT BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - -- ml = milliliter mg/L = milligrams per Liter ND = none detected RESULTS BASED ON SAMPLES SUBMITTED: 12 /18/97 SAMPLE, AS TESTED ABOVE: M or AMNOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) f p b f w Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 0 OUTSIDE CT: 800 - 654 -1230 NORTHEAST LABORATORY OF DANBURY (Formerly Tarlton Environmental Laboratory) CT Cert: PH-0404 39-3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 -(103)-748J7003° LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. PUTNAM AVENUE BREWSTER, N.Y. 10509 DATE SAMPLE COLLECTED: 1/2/98 TIME COLLECTED: 11:42 A.M. COLLECTED BY: R. MILL JR. DATE RECEIVED @ LAB: 1/2/98 TESTED BY: LAB# 11471 REPORT DATE: 1/8/98 SAA1[PLE SITE: DONALD MILL, LOT #!, BATAVIA ROAD,. PUT LAla,-PATTERSON, N.Y. SAMPLING POINT: TOP OF WELL SOURCE: WELL-NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXEMUM CONTAMINANT LEVEL PHYSICALS: CHEMISTRY: pH Turbidity Nitrite N Nitrate N Alkalinity Hardness -- .. - Iron Manganese Sodium Lead 6.97 no designated limit 0.18 NTUs 5 NTUs <0.01 mg/L as N I mg/L as N 6.25 mg/L as N 10 mg/L as N 220.0 mg/L no designated limits 380.0 mg/L no designated limits mg/L, 0.30m /L,:-- .<0.03. <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 110.0** mg/L 20 mg/L** <0.005 mg/L 0.01.5 mg/L ml = milliliter mg/L = milligrams per Liter ND = none detected NTU=Units **Notification Level RESULTS BASED ON SAMPLES SUBMITTED: 1/2/98 (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS) Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037* (860)828-9787 - FAX (860)829-1050 TOLL FREE WITHIN CT: 800-826-0105 e OUTSIDE CT: 800-654-1230 a� ps j I i h I�, y i 2 _ y — CERTI TE OF CONSTRUCTION COMPIi.IANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONS 1<JCTION PERMIT # - ) Located at nAMA\f � 1A, r_.,(7A f.? Town or Village Owner /Applicant Name Tax Map2& , 1- ,y Block �_ Lot Formerly Subdivision Name Subd. Lot # Mailing Address 1= j )EAN & 4 EeAP , Zip i ' g 27) Date Construction Permit Issued by PCHD 4� T- Sepairate Sewerage- System built by �,L�1, L4/� dress AJAJ i._j (� ` Consisting of I C" >1 >1�1 Gallon Septic Tank and LE , S_M W 6- Other Requirements: Water SUIRD11y: Public Supply From Address. 2IM Private Supply Drilled by W 1 L I_ MI 1_1,1 WI -, I hl!%, Address Building Type51`9> "'y j� Has erosion control been completed? 5 Number of Bedrooms �21 Has garbage grinder been installed? N o 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 regulations of the Putnam Co ty Department of Health. Date: j -7 �t) Certified by P.E. R.A. (D gn Professional) Address M I I-!, W -co- KF- �E(66- - ��Nry t S'Irarz- 1`l License # � 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 are subject to modification or change when, in the judgment of the Public Health Director, such revocatign,podification or change is necessary. if 1 pp I n L ��Lw �L Date: �- gy; V� �l • ��� Title: (/"U White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: /I Zi 7 __- ,. _ 5treet:Location:._ F A_27�4-V to ? =D `- ' Owner" Town P,¢-7 r,6R5Z � Permit # P TM # 3� �(– – 9 Subdivision Lot 7 1. Sewage System Area -- a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank siz - 1.000 .........1,250 ......... other ................ b. Septic tank in a evel ................ ............................... c. 10' minimum from foundation .............................. I.......... d. Distribtuion Box 1. All outl— et-I sat same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box g ropgerly set ............................ ................moo ~.Len th required 2 Oo rd .m I Length installed �_ 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... ' 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................. 7. Room allowed for expansion, 100 % ........................ 8. Size of gravel 3/4 - 1' /�" diameter clean ............ . 9. Depth of gravel in trench 12" minimum ............ ... 10. Pipe ends capped ....................... g. Pum -or Dosed Svstems Size of pump chamber ......................... ........ . ,v ..... 2. Overflow tank ........ ............................... .................. 3. Alarm, visual / audio ............................... . 4. Pump easily accessible, manhole to gra . ......... ..... 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 ....................... ............................... IV. Well a: Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship 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 watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 YES NO COMMENTS No Yell f�P�, ✓ A0 1D'5 l bu k,'01 12e Due 4, G " SNOw cover fo l v f \/ V N% aoa )e +o to « -5ure cr o;v e fo b" 5 haw _-mvel %U A c%5 e y# dnr Eo X.> t. N® well oiiherv«Q b e GvvP e 5n V/ ,�l/© G e i�/ov5e vnde eon orm -� MIN f, PUTNAM COUNTY DEPARTMENT OF HEAL'T'H � DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM -f 77, z49, Y1 Owner or Purchaser of Building T-D6R94C — oil ff/ Building Constructed by Location - Street 6T'QV c �9 YJc Building Type Tax Map Block Lot TownNillage Subdivision Name Subdivision Lot # 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 operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month _ Day � Year - Signaturp- 42 l r' _ r� �� �e� Title:. �.r%i9;fs General Contractor (Owner) - Signature Corporatio Name (if corporation) Address: 6,6;t &�� 'Q �- - . -A State Zip 1—.uk-z Corporation Name (if corporation) Address: 37 State /02, Ai Zip 0- /Ir Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM .�� 7 -l1.1i 36- 22- Owner or Purchaser of Building Tax Map Block Lot L_D6,vA Id C, _ Building Constructed by J3A�� ,/,p Location - Street Building Type 1014 Town/Village &G zwlyL Subdivision Name t!',z Subdivision Lot # 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 operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month --�— Day ,3o Year -9!,2 General Contractor (Owner) - Signature Corporatio Name (if corporation) Address:°�Jj' State , Zip 1�r6 Signature - Title:. 0.,/ihffs� /a�� Corporation Name (if corporation) Address: .35 7 n— -e r11� ,T dl State / .Zip 0 Form GS -9 DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building LD,2.Q.? - � a � �° i V Building Constructed by Location - Street Building Type Tax Map Block Lot low rn ,esa A7 Town/Village Subdivision.Name Subdivision Lot # 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 operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month _ / Day 3® Year 9!.2_ General Contractor (Owner) - Signature Corp oratio Name (if corporation) Address: /,4;r- Q�_ . State Zip Cg Signature - Title: Corporation Name (if corporation) Address: .37 ��-/­e Fz,-�, od d State / w /h/ Zip 0- Form GS -91 r++ft Type X Ti i, a-., f 4,1 rat Am 0 i 3G Fm seeuoa aRb LJ Depth VONMO, N Deelp Flow G P D 6 i). // PCHD NodBmdm b Requbed Wb FM `w -Ptabd Sepste Seww.$P a'oatttiat 1 (!)GO r..a.. Sapdk.Taek To M;arttstead.df T� !� Address Watsie park Supply Fireso -Address s...4 D/db'd purr st.4.w.alta l�,Pcy2c�'�'-► c� S Q �2 ..��/ 1 ►present that 1 am wliolly,and completety :responsible for the design and. location of the proposed system(s). lj that the aePerate saw a di sal Rem above described will be constructed is, snown.on -the aPproved,arnendmept.tnere to and,in,aeeordance with the standard s• rums a regulations o ne County ,D"-tment � of Health, and.tket on C900Mkin.Eheraef a.••Certifieate of Construction Compllente•' satiefaetory to the Commi"loner Of MaaRhwill be MOMRted Willie Department, ,and a' written gwiantee will be. furnished the owner, hisaucces o►f, heMSor assigns by the buiMai.that YW builder will in' pod .operating :coiolu06'anY . Csrt of aii. laws"I disposal system durkp the, period of two (2) years liemedlately follower/ the date of the issu. aece of the approval of. the .Certificate. of Construction Corn nce of the o4inal -system of any repairs thweto: Y) that the A►ill" wail desbribed above wIR M located as Ilesrn on.tM pptowd plan and tMt.sakl wail will W InR 1 in aCCOrWnp wRh ter Ra s, rules and reguia�o s of the ►utnam County Department of lees h dab ` �_ c� .. 5 � P.E. ZR.A. l � Adds o �1". No 2-4 APPROVED FOR CONSTRUCTION: This approval expirestwo years_froni the data unless construction of the dwiding 'has been undertaken and is revocable for cause or may. be anmWed.o /modified when Considered necessary, by 'the Commissioner of Health. Any change or alteration of construction "quires now permit , Approved` foror disposal of domesti wnitary sevii a /or private water supply only. Rev. –ate- /= o ��� / 7 Title 10/88 / % A LAURENT ENGINEERING j \ ASSOCIATES, P.C.: MILLBROOKE OFFICE-CENTRE-,' Route 22 & Milltown Road j \ Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS January 28, 1998 Robett Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Don Mill Batavia Road (T) Patterson Dear Mr. Morris: Enclosed are the following: 1. Four (4) prints of Drawing S -2 "As -Built Plan ", dated 1/28/98. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 1/27/98: 3. "Guarantee of Subsurface Sewage Disposal System ", dated 12/30/97. 4. Well Completion Report, dated 12/18/97. 5. Laboratory Reports, dated 12/22/97 and 1/8/98. 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 chols, Jr., P.E. HWN:TR:bd 93077 -1 4 PLn' M DEPAMEn OF BFALTH Lo Z 2._ mI.'Y DIVISION .OF HEALTH •SERVICES - - -. DESIGN- DATA i- SUBSUFACE__SEI?GF.• DISPOSAL ._SYSTEM_ .... __. FIZZ. NJ....'.. OJmei l /ati w %� N� i �l Ad&ess Located at (Street) %���av �, a•2� Sec.32,L(Block / Lot (indicate nearest cross street)' Municipality. PQ Watershed SOIL PEROOiAT'ION••TEST DATA R00U:% M TO HE .SUaqL'1.'I'ED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test 7 /Z .BOLE. • 'NtgMM CLOC'.R TIME Pmcbr=ON PERCOLATION Rn Elapse Depth to Water ]From Water Level No. Time Ground Surface In Inches Soil Rate Stan -Stop Min. Start Slop Drop In Min,/In Drop Inches Inches Inches 12- Zs %, Z.9 , 3 9... - .3 i;9 3 "1; 5°3 10 7-� �.g 2 4„ '5 -1 2 3 4 N'•z'FS: 1... Tests. to be repeated at same depth until apprcximaately equal soil rates . are cbtained at each percolation test hole. . AU data • to' be sukmittbd ' for review. 2.:. Depth measurements- to: be made• from top of hole. TEST PIT • f 1/ APPLICATION DESMIPTION • ' SOIES D=UNMMM IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO._' G. L. - l' i oPtai/- 71c;Plo).L 2' I S +LT?� "4.1 � StLTy Ld4.y 3+ i 41 - 51 SILTY -SOU I. SlLTy gr 10' 11.' 12' .. 13' - 14' INDICATE LEVEL AT WHICH GROUM7 -U= IS EN000N'UM INDICATE LEVEL TO WHICE MTER LF'M RISES AFTER BEING RMUNMUD DEEP HOLE OBSERVATIONS MADE BY: DATE: - DESIGN Soil Rate Used / ` i Min/1" Drop: -S.D. Usable Area Provided No. of Bedrooms 2 Septic Tank Capacity 10-410 gals... Type Absorption Area-.Provided, By 0 G L.F. x 24" width trench Other Name. Signature i..Acyo Address ����; l 1 `f- �� SEAL i TL''�• , t �" No. 55124 t: . °., THIS SPACE FOR USE BY BEAUS DEPART ONLY: Soil Rate Approved sq.ft-,% .- Checked by ' Date LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108- (FA)0 278-2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS ADJACENT PROPERTY OW114ERS DONALD- MILL EAST BRANCH ROAD PATTERSON, NY 36.22-1-31 DiPrinzio, Bernie 22 Veterans Road Patterson., NY 12563 36.22-1-45 Neglia, Stella P.O. Box 172 Patterson, NY 12563 36.22-1-29 Carlucci, Frank & Barbara 16 Veterans Road Patterson, NY 12563 36.22-1-48 Reisinger, Frank & Barbara iw Ve-ter:an Road Patterson., NY 12563* 36.30-1-14 Rule, Robert & Pamela 12 Malone Place Patterson, NY 12563 36.30-1-5 Dalo, Frank & Petrina Fairfield Drive Patterson, NY 12563 l t FORMAT Date 1 -12 -94 s NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Y ti. c DiPrinzio, Bernie RE: Department of Health Review of 22 Veterans Road Proposed Sewage Disposal System for Patterson, NY 12563 property: !, Name: Mr. Donald. E:- Mill Address: East Branch Road Town: Patterson,: NY' 12.563- . . t; Tax. Map i 36.22 -1 -49 Dear Mr. DiPrinzio: By Title Agent RECEIVED BY: Address: Tax Map: JK;cj t , 4 NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Neglia, Stella RE: Department of Health Review of 4' P.O. Box 172 Proposed Sewage Disposal System t: Patterson, NY 12563 for property: Name: Mr. Donald E.. Mill Address: East Branch Road Town: Patterson, NY 12563 ..Tax Map: 36.22 =1 -49 Dear Ms. Neglia: h, Please be advised that an application for a Construction Permits - relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam .County. Department of Health.* Attached please find a copy of the latest s.it,e plaff. If you have any questions, concerns or: information which may bear; on the Health Department's review of _.this app.lication,.you may J call Mr. Hedges or Mr. Morris of the Health Department at -.278= 6.i3Q`. . Very truly youmrs, By Title Agen RECEIVED BY: Address: Tax Map: JK;cj fl FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Date 1 -12 -94 Carlucci, Frank '&.Barbara RE: Department of Health Review of 16 Veterans Road Proposed Sewage Disposal System Patterson, NY 12563 for property: Name:. Mr. Donald E.- Mill . Address: East Branch Road Town:. Patterson,* NY 12563 Tax - Map :. 36.2271 -49.- Dear Mr. & Mrs. Carlucci: r. Please be advised that an application for a Construction Permit - .relati-ve to the construction of a sewage . syst.em.and /or well proposed :f.or the captioned property -has_ been made -; :to `,the: Putnam: .County; .Department. of ,Health. Attached ;please find a_, :latest site plan .. _. If you .-have..any.questions, concerns or information which:may, bear on ..the Health Department's review of this.application, you. may ; call Mr. Hedges or Mr. Morris of the Health Department at .278 = 6130;::: Very truly yours, By Title Agent RECEIVED BY: Address: Tax. Map: JK;cj LAURENT ENGINEERING �j ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE __Roue.22. Ml;nownROed . .... w._ Brewster, New York 10509 RANDOLPH W. LAURENT. P.E. (914)2786108 - (FA)O 278 -2658 HARRY W. NICHOLS JR.. P.E. \ CONSULTING SITE ENGINEERS Date: 1 -13 -94 To: Job No.: Putnam County Health Dept. 93077 4 Geneva Road Project: ' Brewster, NY 10509 Attention: Mr. William Hedges Proposed SSDS Lots 1 & 2 Batavia Road.,.Patterson, NY Gentlemen: We enclose ( 5) copies of :: ® B/W Prints ❑ Reproducibles ❑ Reports ❑ Tracings ❑ Specifications ❑ Memorandum M Copy of Letter ❑ Description: s. Revision /Date No.: SS -1 "Proposed SSDS - Lot #1" Rev. 1 -10 -94 r. SS -2 "Proposed SSDS - Lot #2" Rev. 1 -10 -94 Neighborhood Notification letters and certified mailing receipts 1 -12 -94 Letter from Mr. Ted Kozlowski, E.C. Inspector 1 -18 -94 Revised per your comments. Sent Via: • Our Messenger ❑ Blueprinfer ❑ First Class Mail ❑ Special Delivery • Your Messenger Mand Delivery ❑ Copy to: Mr. D. Mill w /enc . Very truly yours. LAURENT ENGINEERING ASSOCIATES, P.C. Per: U), ~g. p, Har y W. Nichols, Jr., P.E. h., r" a 30 4` ;Z8 ' :.� _ , ,� �,� ! , � , + ,,fig `'9`• /o / . �✓ '� 1�. ate' �� ,��`! �� ` i { xa �;.• � ., , ` _ 7 Moe z Gro c -eye ry. ��.� Y * { bf w+ri , tt •i ;, t t � t r, ai +. -_ — 3t��uxishi uN VA W2-1 At LAURENT ENGINEERING MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278-6108 - (FAX) 278-2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS December, 11 1993 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS. Batavia Road Patterson, N.Y. Dear Bill: Enclosed are the 4ollawing: 1. Four (4) prints of Drawing SS-2 "Proposed SSDS", dated 11-23-93. 2. "Application For Approval of Plans For A Wastewater Disposal System". 3. "Construction Permit for Sewage Disposal System", dated 11--23-93. 4. "Application to Construct a Water Well", dated 11-23-93. 5. "Design Date. Sheet". 6. "Letter of Authorization ", dated 11-23-93. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". B. Check 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. Hak lichols, Jr.. P.E. ct HWN: bd 93077-2 enc. CC., Mr. D. Mill w/enc. piCJTNAL� CO�U'�I•"1`St' DEP,A.RTL�E�T O ]E' k1 DE: A, ]G 7C 1-1 ....APPLI.CATION FOR: APPROVAL OF PLANS FOR A NASTEWATE_R..DISPOSAL SYSTEM. 1 , Name and Address of Applicant:bj�.1 2. Name of Project: 3.._, location d1 V /C: 4. Project Engineer: '� •t�'iL`�' W. `01,5+AOIIS -.�. 5. Address: t4iW"_a_, tZ'(� ?/l f 011, *Wo row License Number: Phone: 1b' _ 61•ob =�a rJ Y f d5oq . 6. TYpe of Project: >t: �/ Private /Residential Food _Service ....Commercial Apartments Institutional Mobile Home Park office Building Realty Subdivision other (specify) 7. Is this project subject`to State Environmental - Quality Review (SEQR)? Type Status (Check One) Type I.-. Exempt ✓ Type II. Unlisted. 8. Is a Draft Environmental Impact Statement (DEIS) required? ................ fJU 9. Has DEIS.been completed and found - .acceptable by Lead,Agency? ..... nj/A 10: Name .of Lead Agency NVA 11. Is.this project i.n. an area under the .control :of -local -- planning, zoning, - -- or other officials -o-rd-inan-ces -- .:.:. : 12. If'so, have plans been _submitted to such, authorities ?..................... WA 13. Has preliminary approva.f been granted by such authorities ?.. M/A Date Granted: 14. Type of Sewage Disposal _System' Discharge ....... Surface water Ll Ground Waters 15. If surface water discharge, what is the stream class designation ?........ O/A :6. Waters index number (surface) ........... ............................... n►�(�_ ;7. Is project located near a public water supply system? �1G S. If yes, name of water supply Distance. td water supply 9. Is project site near a public sewage collection or disposal system ?..... fJo 0. Name of sewage system Q/A Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4 . Project design flow (gallons per day) ...................................... 64V- 25. Is State Pollutant Discharge Elimination'System ( SPDES) Permit required ?.. �Jo 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland? ......................... ............................... ....... n)Q 28. Wetland ID Number .. ............................... )/d 29. -Is Wetland Permit. -required? .............. ............................... Has application been made to Town or Local DEC Office? .......:.......... 0 /A 30. Does project require a DEC Stream Disturbance Permit? tJ D 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 r,)v 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 NO k)d DESCRIBE: 33. Is. there .a local master plane or file: with the Town or Village? ...: ....`. 34. Are community water, sewer facilities planned to be developed within 15 years? NoWtJ 35: Are any sewage disposal areas in excess of 154.slope? .......... ....,....... _ i�10 36. Tax. Hap ID Number ........................... .... .... 1% -M 37. Approved Plans are' to••be< returned to: Applicant _Y"' Engineer If the application is signed by a person other than the applicant shown in Item.1,.the. application 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, under penalty of perjury.- that information provided on this form is true to the best of my know wedge and be 1 ief. Fa lse statements made hU1 ein are punishable a: the Pena J Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: PUTNAM CO= DEPARTMENT OF HEALTH DIVISION OF ENVIRMMMI, HEALTH SERVIMN DESIGN DATA SHEET- SUBSUFACE S9gAGE DISPOSAL SYSTEM FILE NO. .... . ........ Address';(L�;' Located at ( Street) L7::--, Sec. ,2�-Block �_ Lot (indicate nearest cross street) Municipality p Watershed Pd �T .SOIL PERCOLATION TEST DATA RDQ(TLE2ID.TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking p �%j aj� Date of Percolation Test HOLE 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 2 2; 41 Iq : �t• 3 2 (Z 2 to 4 j {2 1• �o ► g 21 �. b s. 1 2 4 I ZZ I qo 2e 7 11 /• 7 5 1 •_2 _ 12• o � 2 '� 5 2 Z4 3 �,o 5 NOT'E'S: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to' be suhraitt�d for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED. WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. H012 W. v Hoiz NO. i - -.. .._ G.L., lr 2' 3' 4' D 5' 61 7' 81 1 ill 9` ' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDFMTER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LE'VEI, RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used — Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms ;j Septic. Tank Capacity jam gals. Type Z,,IK. Absorption Area .Provided By �?txV L.F. x 24" width trench Other Name i-��`( �i.ly� �d2 . Signature Address All i SEAL.; � 4s No. 56124 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 Re: Property of Located at IA�Af -=� -- -- - - - (T) d Section �1j/o. /f,� Block tot Subdivision of Subdv. . Lot # Gentlemen: Filed Map # Date This letter is to authorize / UU a duly licensed professional engineer 1/ 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 with-: the. provisions of Article - -1-4-5 - -or - -_ -- _- - - -: 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Counter P.E.., R.A., T e 1-6 ph 6 ne Very truly yours, Signed //1 _�_/ / • ge A , • �' .. - ol�7o0 aJ `f . 12t,�0;2 Toi-m Telephone APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS - - :REVIEW: SHEET for CONSTRUCTION PE M T .._. ._..._.......... ... ..,.._.. JA.MT OF C���iER / STREET LO TIGti Y DATE TAX MAP 4 DOCUMENTS. � G��_ v ISCHARGE (OK) PFR3�T APPLICATION HOLES LOCATED fTT; PWS LETTER EOD s EYTATIVE OF PRIMARY AND EXP.k SIGN AUTHORIZATION A; SHOWN; GRAVITY FLOW, SUF .SIZE CA SHEET(DDS) ^�=� -VTED PIT & D BOX SHOWN & DET.AILED L aHOUS -E - NO. OF BEDROOMS � CG T PERC RESULT 4�tjEL1=S & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM DEPTH Q— ROPERTY METES & BOUNDS .OUSE SEUTAC•�3 TOT) THREE SETS PLANS - TWO SETS VARLANCE It l.: vvL J SLED IG . I SION APPROVAL CHECKED PERC RATE 5LL4�EQUIRED�,Q'� - CURTAIN DRAIN REQUIRED MSTAINTDPIPES -APPROV J. LOTS__'���! 4V E L (TOWN PERbIIT R & D) �AT.a ON DDS PLAINS & PERNUT SA, fE NO =CLAYBAP l0 FT HOF = FILL SPE =DEPTH G FILL PRO] m VOLUME - 1 /4 75T. 4 "0; TYPE FILL SYSTEMS AL: SLOPE 3:1 TO GRAD R PROVIDED ff i NC7►` /7:Z�] /tS�101 S -1? D'� - SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR: FLOOD ELEVATION FIELDS , UIRED DETAILS ON PLANS Ela TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NORTH ARROW) UL;G'-T-a fOUNDAnON WALLS JSD&+MRAULIC PROFILE m GRAVITY FLOW F=�- WELL, 200' IN D.L.O.D., 150' PITS >�aOX M TRENCH/GALLEY Liz P- PIT DETAILS STREAM WATERCOURSE LAKE (INC.EXPAN), ,:F.I✓FIC TANK - SIZE, DETAIL 'CATCH BASIN, 35' STORtiiDRAIN, PIPED WATER I: DETAIL, SERVICE LICE IF OVER O WATER LINE (PITS -20') ;t3NS"iRUCTION NOTES (GRINDER RATE) NTERMITTENT DRAINAGE COURSE I N DATA: PERC AND DEEP RESULTS -QD=FT, RESERVOIR, ETCM 150 FT. GALLEY SYSTEMS XO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS DRA--EWAY�& SLOPES CUT ©10' FROM FOUNDATION; 50' TO WELL EG9MNGiGUTTER/CURTAIN DRAINS - - -- ♦ ED 15'«ELLTOP. SUPERVISOR Lawrence M. Lawlor (914) 878 -6564 TOWN COUNSEL Jacobowitz & Gubits (914) 778 -2121 427 -2101 Fax (914) 778-5173 ROUTES 164 & 311 PATTERSON, NEW YORK 12563 Jan. 8 1994 8 367? TOWN BOARD Thomas. -.T:. Keasbay Marilynn Reed Kelly John Owen Deborah W. Taylor TOWN CLERK Rose Beers (914) 878 -6500 Mr. Harky Nichols, P.E. Laurent Engineering Route 22 Millbrook Commons Brewster, NY 10509 Dear Mr. Nichols: After inspecting lot 1A, owned by.Mr. Mill, off Batavia Road in Putnam Lake, I have determined that there is no regulated Town wetland immediately on site or within 100 feet of the site. :Lot .B'..,does not contain any wetland but there. is'.a Town regulated wetland within 100 feet to the -North of this lot. If you have any guestions, please contact me at 878 -6500. //JJ Ted Kozlo. ki Environme tal Conservation Inspector DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 AP Llir; IONT 10 `CONS T RU V A -WATER W=L ft PCHD PERMIT # _�_ WELL LOCATION Street Address own Village City Tax C' Grid Number , Al WELL OWNER ame �L ailing A dre CIPriva e O Public USE OF WELL 0- primary 2- secondary )0 RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION O INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# EI REPLACE EXISTING SUPPLY 12NEW SUPPLY NEW DWELLING) PEOPLE SERVED, /EST. OF DAILY USAGE gb"l Sal O TEST/ OBSERVATION 12. ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL . REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG C1 GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name MM Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: /ps TOWN /VIL /CITY if DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID ON SEPARATE SHEET n �, L-, r, J = (date) /I(sigliatureY 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 contaminate surface or groundwater. Date of Issue:Gi 19 7 C 19 Permit Issuing Date of Expiration - "_ �� g Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DIVISION • RMIIUIMy v •ly 'SEW ICES :._. ::- ... -�:. - .. .. ': - !^ CYO•'. •!•, .• • DESIGN Owner Address ra.��` j.�.ta, ,,� Y Located at (S- treet) �j �'a,,; �Lu 2� Sec. 32, �1 Block / Lot (indicate nearest cross street)' Municipality PS -Y(- o Watershed z ` 3 Z ?,'-121 �Z .3 9 "�3 l; s3 CQ �-4 /A �9��r 3 .3 . �Z . 4 F1 r_ 5 NOM:_ 1... Tests to be repeated. at same depth until apprOdmtely eqLz I soil rates. are obtained .at each percolation test hole. All data to'be submitt!d for review. ' 2.:. Depth neasurements. to be made fran top of hole. i SOIL PEROOLATIC M _.TEST DATA PZQLT1FtED TO BE . SUEM I= WITS APPLICATIONS Date of Pre-Soaking %- R Date of Percolation Test 2_1 C HOLE • NCPiSER Cr= TIME PERC`.QiATION PF.RC)O=CN Run Elapse Depth to Water TYan Water Level No. Tiny Ground Surface In inches .Soil Rate •. Stmt Stop Min: Start Stop Drop In Min/In Drop Inches Inches Inches 1 Q. r 5 q; 2a 12- zs% 2-9 l :3 4 .. . - z ` 3 Z ?,'-121 �Z .3 9 "�3 l; s3 CQ �-4 /A �9��r 3 .3 . �Z . 4 F1 r_ 5 NOM:_ 1... Tests to be repeated. at same depth until apprOdmtely eqLz I soil rates. are obtained .at each percolation test hole. All data to'be submitt!d for review. ' 2.:. Depth neasurements. to be made fran top of hole. i 4' 5' 6' , 7' — 8' 9' S•iLT y SA-NIJ SiL-Ty S4hj) 10' 13r 141 _.. INDICATE LEVEL AT WHICH GROQNMATER IS ENCOUNTERED INDICATE LE,'VEL TO WHICH WATER LEVEL RISES AFTER BEING ENOMnIPM DEEP SOLE OBSERVATIONS MADEiBY: Y e-r DATE: DESIGN •` Soil Rate Used 4 - i Min/1" Drop: S.D. Usable Area Provided. No. of Bedroans Z Septic Tank Capacity C 0.0 o gals. Type Absorption A.rea'.Provided By 06 L.F. x 24" width trench Other Name. Signature Address �4 ��!� L �� � c SEAL I No. 56124 03IS SPACE FOR USE BY HEALTH DEPAREMU. Ot1hY: Soil Rate Approved sq. f t,/ I.' -Checked by Date 1 � t rIor1lle *gn� fv 62� i t 0 ) i i i EXISTING 61ZApE PROP05E0 6R.41� -'120 50 P(z,OP. SPOT G&AD.c= Ro. 1 FD - K6?OF MAIN 4 FOOTINIl PKAIN * PT. FeKC. TEST LOCATI,J* 4 T. f' TEST PIT LOCATION;. + �tGi111tla Wel-1- . I !� PR ✓Pvy�CJ 5�vs �: �ROJEC7 - -- ---- PROPOSED SSDS,, PIATAVIA �OAt7 F. V014,4147 1?,. MIL, �. {CAI -IGH (zDAt7 LAURENT ENGINEERNG ASSOCIATES, P Ct1 MILLBROOKE OFFICE CENTRV_ qy Route 22 & &Iilltown Road 4r . Brewster, New York 10509 t (914)278 -6108- (FAX)278 -2658 t; CONSULTING SITE ENGINE�:RS PROPOSED SSDS: SCALE lu= 20r 5 DA'E DRAWN B• �V7 ;)anw ^.G N. � n - ,LI fi G� s; s. s '1: L 11v1L'1\J1V 114 %- ,11H1%1 `111 IL.) No. A B / /4.0 31.0 2 9410 98. D 3 87-5 97.0 4 52.0 48.0 5 49.0 480 (1 147.0 149.0 7 /670 /49.0 i S 4553 30 'W / J-&7' N'9• 2 i i. NIF DAL 0 B Op, iV.�O'S9'00 "W z�• W Z4.Y0' � y L4Y OEZbBRy Ag57EEvV ,y. 3 ��LVOrpy +, i 6 ^TANK � � - : -. .i •.- _ A t \/4' j 5 40.00 "E TA VIA ROAD BA j: 1 I J� i r R� ! i' T� S' J'. J. J ^ f,