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HomeMy WebLinkAbout1917DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.23 -1 -3 BOX 17 Iry ro rw aim T 0 2 r �` r ` 4 1. L' 1 I 'l Ilm r ti In 01917 s J SITE LOCATION OWNER'S NAME MAILING ADDRE APPLICANT PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES41, .4)SAL. F:OR .SEWAGE,TREATMESVT-SYSTEM REPAIR II/' Of Internal Use Only PERMIT-# Llr Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC - manned wetlanl c ao C-m!� !Z ye_ J Not in Water, L)' Delegated ❑ Joint Review TM # PHONE # / Name & ReVationship (i.e- Awner, tenant, contractor) DATE L31101 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER `� PHONE # 29911 ADDRESS rkil REGISTRATION /LICENSE # 10 G fo, Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200. feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree to the conditions s ated on thi form SIGNATURE TITLE DATE (owner) - -- -I; the-septic instaliw,-agree to com ply- with -the-co-nditions of this permit forthe septic system-repair - - - SIGNATURE TITLE e,$ DATE d 9 (installer) Proposal approved with the follo conditions: r 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved std Proposal Denied ❑ n �� In ector's Signature & Titles Date Expir lion Date Re air proposal is in compliance with applicable codes Yes 0 No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 JUL-31 -2009 10:57AM FROM - ENVIRONMENTAL HEALTH ,l f� V::--i m, % ~� s c 8452787911 T -971 P- 002/004 F -197 -ANR%-z. w o p -�- LA r Volt I � a >- 30.7 go - m, % ~� s c 8452787911 T -971 P- 002/004 F -197 -ANR%-z. w o p -�- LA r Volt I o ILL' PUT-N-A.-M COUINTY DEP--A.RTIMENT OF HEALTH A_ -IRO NIVIE- NTAL,11EALTH SE:RVICE"-S DIVISION Or ENV DESIGN DATA SHEET — SUBSURFACE SE'W'AGE TREATMENT SYSTEM ,Owner: Located at (street): t9f -e a-, Municipality:` Address: TM # Section: Block Lot Watershed: SOIL PERCOLATION TEST DATA Witnessed by, 112A, 'r. w . - Date of Pre-soalcing: Date of Percolation Test; 7 L3 Hoie No. Run No. Time Start — Stop Elapse Time Depth to water from f Found surface (inches) Start - Stop Water Percolation level drop i ate in inches min/inch .0 3 2 :t -j,SI i a f Eli -- — ------- 4 _7 �2 _V 2 j 'Q.3 I -3 3 alo -3 4 0 A7- 10 1 C/ ag- 2 I. 3 4 2 3 4 J IN 0 te S': 1. Tests to be -,toeattd at same depth until ar.cm-diinaLell-," _-qua! percolation rates are obtained a, each percolation -.es: hole. < I rain -for -30 min, inch, < 2 min foi- 31 -60 mnvinch.i: Ai] data to be submitted for review. 2. Deoth measurements to be made from tor., of note. JUL -31 -2009 10:57AM FROM - ENVIRONMENTAL HEALTH 8452787921 T -971 P.001 /004 F -197 e I ti PUTN-?Vvl COUNTY DEPARTME- T OF HE AL7'H DIVISION OL ENVIRO NIF.NT -U HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATNIE-I'T SYSTE -M Owner: �O►rrG. �`�. Address Located ar tstreet,: Yt Ai 3b•�i Tivl R Section: Elluck f Lot 3 Municipulify, watershed: SOIL. PEROOL4,TiOti TEST DALk Witnessed by: S 6�, 'OGGIr Date of Pre - soaking: Date of Percolation Test: 3a p S Depth to j fro I Time Elapse water groun d m I Water I Perpolation Hole -No. i Run No. Start — I Time level; drop ; Rate I Stop (mita.) I ( surface I in Inches j min /inch Start - Ston I ; 7 1 3 I 3 Liza- 3-7-1 ► 1 I 1 1 3 -7 'I L., 4... 4' fa sl I ' La, ON . a -3 k 3 1 3 I i Ira.- ►:ol I �� I ao - a3 „3 N . I 3 1� 4 I I 1 1 I I 4 ' ?� p tes: I TegtS to �e tsasatzo ai same un.-L' 3rL73 =ua! perco.muor, ra(es ar_ obtain 8; :3cr. pt'-nniation :8s: haiz. I:.e.. i II1li .;0' i -;}": nun:'inco. c = t*lir. loi :3: -r)( r ru.1. incr. � All date ic. he submitted for review '_. Dea:n rn-!aTjr_mc:tts co :ie r:taoe from tor. of nolc. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES :w -- -THIS IS NOT A REPAIR PERMIT PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE All 'information below must be f & completed prior to any scheduling SITE LOCATION LS �'4p, bk- TOWN 13, TM # �C' 3 1 y 3. OWNER'S NAME -, n -nie Pr4l PHONE MAILING ADDRESS Af PROPOSED CONTRACTOR/INST'ALLER ) ONE # ADDRESS ��fU y d C r �/gRECiIST iAT10N /L'ICENSE# !season for axpioration: - 0 failure to. surface I0: backup in house 0 find 16nits of systEmn for repair her (explain below) FOR QQUNTY USE ONLY & Tate Dam Date: '42 � J'S Ttme: k1r.excel:septic Z -d 6969-6LZ (91W IIEPuAl 89E :60 60 ZZ Inf f. 'r k1r.excel:septic Z -d 6969-6LZ (91W IIEPuAl 89E :60 60 ZZ Inf c r V !i PUTNAM COUNTY DEPARTMENT OF HEALTH - - ...DIVISION OF ENVIRONMENTAL HEALTH RYIC�S_ I{Ale0Permit# WELL COMPLETION REPORT Well Location Street Address: 20 Empire Drive Town/Village: Patterson Tax Map # 372 4003 62312 Map36.23 Block 1 Lot(s) 3 Well Owner: Name: Address: Roseanne Porrato 20 Empire Drive - Patterson, NY 12563 Use of Well: 1- Primary X 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion _XCompressed air percussion _Other(specify) Well Type Screened _Open end casing _2L Open hole in bedrock _Other Casing Details Total Length 90 ft. Length below gradeft. Diameter 6 in. Weight per foot 171b /ft Materials: Steel Plastic Other Joints: Welded X Threaded _ Other Seal: Cement grout X Bentonite Other Drive shoe: X Yes _ No Liner: _Yes X No Screen Details Diameter (in) Slot Size Length ft Dept to Screen ft Developed? First _Yes _No Hours Second Well Yield Test _Bailed _Pumped .X Compressed Air Hours 6 lyield 7.5 gpm Depth Date Measure from land surface - static (specify k 60 During yield test (ft) 380 Depth of completed well in ft. 645 Well Log If more detailed inforrRation- �- descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface------ �or 0 30 Dario Granite R5 7.5 Grey Granite If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information. 645 7.5 Pump Type submersible Capacity Depth 500 ModellOGS20412 Voltage 230 HP 2 Tank Type n Volume 86 Date Well Completed` DrillerPC Certificate,# 023-07'NY State # 10Q7� s PumpInstaller PC Certlflcateh #02 Date of Repo1Well Well Driller Na me 8� Address,; g xy :lulIlg, J 11C 75 Putnam' AVeriue . $rewster, v` rV , m•.t..x.y N ., aWa.+sFn�: - ,ycr > :,' Pump Installer Narne 8►Address ; , �� `��, E� d''' 07 ""% �.Z,3, t.l.,i; @3'dv:'ik . .3a � b ° 1,.^,R .. C _ 'k i kie .w+Y .fM'A d k Pumipin (signature) ,s��,rC . 'e •'3° ' Kd NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on ep rate sheet/pian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 R D Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH r DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.:..,.. „- ,.. WELL ABANDONMENT- REPORT I, undersigned; .hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # AW10-07 to abandon id wate well. 07 l Date. �/ Signature: Print Name: Robert M. Mill, Jr. 75 Putnam Avenue Address: Brewster, NY 10509 PCHD Well Abandonment Permit # AW10-07 please, print or type Street Address: TownNillage Tax Grid # 372 4003 62313 Empire Drive Patterson Map •23Block 1 Lot 3 _•!,: Name: Address: Rosear nie Porrato 20 Empire Drive - Patterson, NY 12563 S:ivk 1 5 X Drilled Driven Dug Gravel Other Well Depth 126 ft Static Water Level ft Date Measured Low yielding — shallow P ti pipletiet`VQ', Fill concrete from bottom to top .of well a:�� VL I, undersigned; .hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # AW10-07 to abandon id wate well. 07 l Date. �/ Signature: Print Name: Robert M. Mill, Jr. 75 Putnam Avenue Address: Brewster, NY 10509 �7 Envrreamental Services rrlc 41 KenoslaAvenue CUtf , Page. 1 of 1 t "r;�,TEA; SC�ft r��� AtA A�V�LYSlS Danbury, Connecticut oBaiO I Telephone 203 -798-2229 ..IViill Drilling Co, �__ :,�,_� . _ - . _, , . • •,�,, � . r T Mailing Information: Collector's Information: JMS ID: 060752 Name: Mill Drilling Co Name: Robbie Mill Address: 75 Putnam. Avenue Address of site: Roseannie Poraita 20 Empire Drive City: Brewster State: NY Phone: (845) 279 -5041 Zip: 10509 Fax: (845) 279 -5075 City: Brewster State: NY Phone: Zip: Sample's Information: Site: Hose Bib Date Collected: 9/4/2007 Date Received: 9/4/2007 Preservative: HNO1 Time Collected: 9:30:00 AM Time Received: 11:30:00 AM Temperature: <4 Lab No.: J0709366 Matrix: Water Date Analyzed 09/05/07 09/05/07 09/04/07 09/04/07 09/04/07 09/05/07 09/04/07 09/05/07 09/05/07 09/05/07 09/05/07 -- - - 09/05/07 09/04/07 09/04/07 09/04/07 Test Name Result MCL Method Manganese <0.05 ppm 0.3 ppm SM 3111-B Sodium 44.8 ppm N/A SM 3111 B pH *9.27 S.U. 6.5 -8.5 S.U. SM 4500 H B Color ND 15 Units SMWW 2120 B Turbidity 1.94 ntu 5 ntu SMWW 2130 B Hardness 8 mg /L N/A SMWW 2340 C Odor 1 mg /L N/A SMWW 2340 C Iron 0.12 ppm 0.3 ppm SMWW 3111 B Chloride 22.2 ppm 250 ppm SMWW 4110 B Nitrate 0.33 ppm 10 ppm SMWW 4110 B Nitrite -:. n <0,05•ppirim.-.. _ .. ..1 -ppm.. _, -SMWW 4110 B... `......- Sulfate 11.8 ppm 250 ppm SMWW 4110 B Chlorine Free Residual <0.1 mg/L N/A SMWW 4500CIG E. Coli Absent Absent SMWW 9223 B Total Coliform ** *Present Absent SMWW 9223 B Comments: *ABOVE MCL ** *ABOVE ACTION LEVEL At the time of the analysis the sample was Unacceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg /L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit Units = Units Signature: Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 oONN6c-TIGUT. NE''V YORK AND NELAC CF- RTINED Toll Free 866 - JMS -5097 1 Corporate Fax 203- 796 -2408 1 Lab Fax 203 -795 -2187 1 www.jmsenvironn-erdal. ccrn :7 � l ��- Page 1 of 1 invireamental Servloes, trio. 41 KenosiaAvenue tVATEA, SO(L A)YV AM AMA r YS S Danbury. Con rrectiCUt 0681© I Telephone 203 -798 -2229 Mill Drilling Co Mailing Information: Collector's Information: JMS ID: 061905 Name: Mill Drilling Co Name: Russ Mill Address: 75 Putnam Avenue Address of site: Porrata 20 Empire Drive City: Brewster City: Patterson State: NY 'Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Site: Bottom of Tank Date Collected: 10/4/2007 Date Received: .10/4/2007 Preservative: N/A Time Collected: 12:30:00 PM Time Received: 12:50:00 PM Temperature: <4 Lab No.: J0710477 Matrix: Water Date Analyzed Test Name 10/04/07 Chlorine Free.Residual 10/04/07 3:45 PM E. Coli 10/04/07 3:45 PM Total Coliform Result MCL Method <0.1 mg /L N/A SMWW 4500CIG Absent Absent SMWW 9223 B Absent Absent SMWW 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg /L = milligrams per Liter N/A = Not Applicable Signature: _ Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 C! �NNECTIGLIT. h IPAC YORK AND N[;L..!C CERTIFIED Toll Free 666- JMS -5097 1 Corporate Fax 203- 79B -240a I Lab Fax 203 - 798 -2107 1 www jrnsenvironrrent3Lccm lei i- ~..i�`�_. N � N C! �NNECTIGLIT. h IPAC YORK AND N[;L..!C CERTIFIED Toll Free 666- JMS -5097 1 Corporate Fax 203- 79B -240a I Lab Fax 203 - 798 -2107 1 www jrnsenvironrrent3Lccm SHERLITA AMLER, MD, IBIS, FAAP Commissioner of Health LORETTA MOLINARI, RN, NISN Associate Commissioner of Health Rob Mill 75 Putnam Ave. Brewster, NY 10509 July 25, 2007 Dear Mr. Mill: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Porrata 20 Empire Dr. (T) Patterson A field inspection was conducted at the above referenced lot by Mitchell Lee, Public Health, Technician. The application to drill a new well is approved with the following stipulations: 1. The well is to be constructed with a minimum casing length of 87 feet. 2. Due to the close proximity of the proposed well to the property line, it is this Department's recommendation that the well be survey located by a New York State Licensed Surveyor. 3.. The well pump and all electrical components. are to be removed from the existing well once it is abandoned. 4. A well abandonment report form (WAR -97) is included for your use, and must be submitted within thirty days of the abandonment of the old well. 5. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact me at (845) 225 -5186 ext. 2233 if you have any questions. cc: frle- S' ce el V h Mitchell D. Lee Public Health Technician Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ch��1c +077 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please p"nnt or type PCHD Permit # k/57-0 J Well Location: Street Address: Town/Village Tax Grid # 372 4003 62312 20 fore Drive Patterson Map 36,23 Block I Lot(s) 3 Well Owner: Name: Address: Roseannie Porrata 20 ftire Drive Patterson, NY 12563 Use of Well:_ Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary 2- secondary Business Farm Test/Monitoring Other (specify) Industrial Institutional Standby Amount of Use Yield Sought __5— gpm # People Served _3_ Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason HAS S KLOW DR= WELL WUH VERY LOW YBU for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes No X Name of subdivision Lot No. Water Well Contractor: Nfi 11 Dri l l;ng, Tnr _ Address: ' 75 p„tnam Ave , Br€ k=x, NY Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to pr i o sep to sheet/plan. Date: 7/6/07 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller c ified by Putnam County. , L Date of Issue —M '0-7 Permit Issuin fficia . Date of Expiration —OC7, Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1 ! APPLICATION TO ABANDON A WATER WELL .please print or type PCHD PERMIT # AM/ / O --O`� Well Location: Street Address: TownNillage Tax Grid # 372 4003 62313 20 Empire Drive Patterson, NY Map. Block Lot(s) Well Owner: Name: Address: Raseannie Porrata 20 re i Drive Patterson. , NY 12563 Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth n/a ft Static Water Level ft Date Measured Use of Well:. R Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primaryxxxx T Business Farm Test/Observation Other (specify): 2-secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Mill Drilling, Inc • 75 Putnam Avenue — Brewster, NY Reason For Abandonment: Has shallow drilled well with very little yield Description of Work To Be Performed: FILL OONCRETE FRCM B(n'ICM TO MP Date: Applicant Signature: PEA! ET This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well., the applicant shall submit to the Department a certified statement that the information elineated on the application for this permit has been completed. Date of Issue Permit Issuiri O cial itl White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well Form WA -97 1% �-----Fl t 1 t 1 Av L; j f Z{ IZ. r i r- I -- IL, air L --� 7b 14-M -'7 ---r as 7 8 -A*Au C.N/f 5 PAW c:) C-0/7 PAW —7 21.43 C-Aw "04,0 CAM C-mv C-40m. lo, 8 — — — — — — — - -- — - - - C-tn7 -o 60 — — — — — — — — — — — — - C-AVI 9 e-.Om C> - — — — -- - - - - -- — — .oe 10, le (n CAW c-d01Y CL m le C> C171J C-" 'e lo, 5 .e - - - - -- — - -- — — -- — — — — — cane C-.VM cv - - -c — — -- cirri - -- -NI? 9 i lo, it -mm ------ - - - - -- / C-.V/f C-,?7m .0e lo, 155.44 1!!!1 / / 112.9 / 36.55/ I., lo 4F Alve / C 1M /1 IC-&1 IC -N/j IJ oj cw c4m / 62 '00 4 '0' .oe 63 /c c 4'Aw c AAM -Am 64 C Fill.. lool ol' lo� A 6 /\/ .le -ec-AMP c 67 lo, 1 vew lo, Fj. ol 2 1po 4- lool P/O P/' W 36.31 - Io443 30174 36.31-1- N 9590010 REVISIONS FOR ASSESSMENT PURPOSES ONLY I SCHOOL -S, NOT TO BE USED FOR CONVEYANCES I ME -F- MUND By JAMES W. SEWALL COMPANY 147 CENTER STREET, OLD TOWN, MAINEm- O ROAD 7 C+ 8 N / / C-tR>t1 21.49 / /c op i� / / / / / / R` / 2E / .00 / . i a. / / / de/ / A�W / / / / C L996 / / / 'or-1w / / C-Aw 2839 / / � / 'b / 4 / / / / / 3 / / / / / / 67/ it`d' c1 / / / / / e /2 / to ool I 1A P/0 / / P/0 36.31 -043 36.914 �! _ N 939000 FOR ASSESSMENT PURPOSES ONLY NOT TO BE USED FOR CONVEYANCES P9ffi mw ff JAMES W. SEWALL COMPANY 147 CENTER STREET, OLD TOWN, MA INE L REVISIONS I � 36.31 - I �5 4 C P1PRf m A � � C tll% — c -tnv N C P7� C-Plit9<' c t>� c t, aLnVUL FIRE -F- . ......... .V - IC 6n� � Ay',r\e- S 0