HomeMy WebLinkAbout2008PUTNAM COUNTY DEPARTMENT OF HEALTH
-D1 IO-N.-OF_,- NVIRONME,N-T.--L.HEALTH
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # PL' %0 " 0"0
Located at���i
Owner /Applicant Name �"'� ` L' C4 H6 _JW0)'
Formerly
Town or Village M75F?" 5 ®H
Tax Map %A Block Lot 41�5'
Subdivision Name P�ow L -g
Subd. Lot # i G iI G i
Mailing Address I) 93 Zip I �� 1
Date Construction Permit Issued by PCHD Ia
Separate Sewerage System built by �d 1 `U' C b 0 `'� 004 Address 1111 V �? K t� BgWi ; 4?� M0
Consisting of 1 000 Gallon Septic Tank and
Other Requirements:
U0 i _p ks r fwe"
Water Sup&: Public Supply From Address
or: 54-. Private Supply Drilled by ft PF-�VL N� Address -15 VTOAn N- W�6B-t�l i0�01
-HasetosiotrcZm "awl °be�nccir�ip�e�ed ?--_._- •.- .----- .-:'--
_.....
Number of Bedrooms 4'J Has garbage grinder been installed?
Nt
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 County Depa}imejq oAHealth.
Date: 19--A-04 Certified by _;
Address
P.E._ R.A.
License # 6 o lA
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
revocation, modificatiaor— change ' is necessary.`
By Title: ��' C / �.-= Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professi nal
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
W$Il Location - - •'
Street Address: - -
-2Albion Drive
Town/Village: `' " '
Patterson
Tax` Grid
Map %1`11hBlock % Lot(s)40,
Well Owner:
Name: Address:
RIC CONSTRUCTION — John Petrillo 73 Garrity Road.— Brewster, NY 10509
Use of Well:
1- primary xxxx
2-secondary
Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open Bole in bedrock Other
Casing Details
Total length 1�_ft.
Length below grade 105 ft.
Diameter 6 in.
Weight per foot 17 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: _ Welded X Threaded _ Other
Seal: _ Cement grout X Bentonite Other
Drive shoe: Yes No
Liner _ Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes No
Hours
Second
Well Yield Test
_ Bailed Pumped X Compressed Air
Hours 6
Yield 80 gpm
Depth Data
Measure from land surface - static (specify ft)
40
During yield test(ft)
280
Depth of completed well in feet
305
Well Log
If more detailed
information
descriptions or
sieve analyses .:. --
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
20
Sand & Gravel
20
200
Granite with seams quartz
200 .:. -
305
80
1 6"
Nedium. Hard :Granite.
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type : � Capacity j j_V v�
Depth 2WBY Model 7614031;Li
Voltage OTHBRS23) HP a/,,
Tank Type WX -36.Z Volume 96-
305
80 gpm
Date Well Completed
8/23/04
Putnam County Certification No.
02
Date of Report
8/25/04
We
-4v7
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan.
Well Dril e 41 RI ' G, INC. Address: 75 Putnam Ave., Br-ewster,NY
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
JMS ENVIRONMENTAL SERVICES, INC.
1500 SUMMER STREET
S TAM FOR D, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory.._
Mailing Information:
Name: Mill Drilling Co.
Address: 75 Putnam Ave
City: Brewster
State: NY
Telephone
Sample's Information:
Client: RIC Construction
Zip: 10509
Fax: 845 - 279 -5075
Collector's Information:
Name: Russ
Address of site: Albion Drive
City: Patterson
State: NY Zip:
Telephone:
Site: Top of Well Date Collected: 9/2/04 Date Received: 9/3/04
Preservative: HNO3 Time Collected: 4:00pm Time Received: 12:30pm
Temperature: <4C Lab No.: J049218
Date Analyzed Test Name
9/3/04 16:00
Total Coliform
9/3/04
Chlorine Free Residual
9/3/04
Color
9/3/04
Odor
9/7/04
Iron
9/7/04
Manganese
9/7/04
Sodium
9/7/04
Chloride
9/7/04
Hardness
._- 9/ 7./04._....__._-- __._::__._N!tr�t
N/A
9/7/04 10:00
Nitrite
9/3/04
pH
9/7/04
Sulfate
9/3/04
Turbidity
9/7/04
Lead
Result MCL Method
Absent
Absent
SMWW 9222B
<0.1 mg /L
N/A
SMWW 4500CIG
ND
15 Units
SMWW 2120 B
ND
3 TONs
SMWW 2150 B
<0.050 mg /L
0.3 mg /L
SMWW 3111 B
<0.050 mg /L
0.3 mg /L
SMWW 3111 B
8.08 mg /L
N/A
SMWW 3111 B
21 mg /L
250 mg /L
SMWW 4500 Cl C
166 mg /L
N/A
SMWW 2340 C
- mcj/L.::
_.�:::_ 1O.mg /L� ._�- .;::__:.......SIVIM
4500_11:03E -- - - -- -- :::
<0.1 mg /L
1.0 mg /L
SMWW 4500 NO3E
6.68 S.U.
6.5 -8.5 S.U.
SMWW 4500 H B
19.7 mg /L
250 mg /L
SMWW 4500 SO4F
0.38 NTU
5 NTUs
SMWW 2130 B
1.16 ug /L
15 ug /L
SMWW 3113 B
At the time of analysis the sample was acceptable for total coliform
N/A = Not Applicable
S.U.= Standard Unit
MCL- Max. Contaminant Level
ug /L- micrograms per Liter
Signature: '�'
Michael Lapman
President
mg /L- milligrams per Liter ND- None Detected
NTU- Nephelometric Turbidity Unit
TON- Threshold Odor Number
� I
Reviewed by:�t
Sharon Houlahan, Director
State #: PH -0218
ELAP M 11715
Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com
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December 13, 2004
William Hedges
Putnam County Health Department
1 Geneva Road
Brewster, NY 10509
Harry W. Nichols Jr., P.E.
Patterson Park - Suite 106
2050 Route 22
Brewster, NY 10509
Fax: (845) 279-4567
Email: hnengineer@aol.com
RE: Individual SSTS Compliance - R.I.C. Construction
2 Aubion Road
Patterson, N.Y.
T.M. #36.33-1-43
Dear Bill.
Enclosed are the following:
1. Five (5) prints of Drawing S-1, "As-Built Plan", dated 12/13/04.
2. "Certificate of Construction Compliance for Sewage Disposal System", dated
12/13/04------
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System",
dated 12/13/04.
4. Well Log, dated 09/01/04.
5. Water Test, dated 09/07/04.
6. E -911 address verification form.
Kindly process the enclosed at your earliest convenience.
Very truly yours,
Harry W. Nic ols Jr., P.E.
HWN:gav
03-080.00
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° PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
please print or type-
Well PCHD Permlt # R-36-0-o,7
Location:
Street Address: Town/Village Tax Grid #
w �� °N. 'o Map 3K,;33 Block l Lot(s) -}J 421
Well Owner:
Name
Address: yi
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought T" gpm # People Served 27 Est. of Daily Usage G,00 gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
✓New Supply (new dwe ing) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes_V_ No
Name of subdivision %�v��ti..., % Lot No.
Water Well Contractor: Address:
Is Public Water Supply available to site? .................................. ............................... No 1/
nYes
Name of Public Water Supply: All,,4-- Town/Village
Distance to property from nearest water main: A/
Proposed well location & sources of contaminatio o be provided on separate s e plan.
Date: `� -14- Applicant Signature:.
"P,
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 certified by Putnam
County. --�
Date of Issue `� �--- Permit Issuing Offici
Date of Expiration 2® "d Title:
n e
Permit is Non -Trarrab a
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
W
d-
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # R'EP AI I L - �30
Located at AL4510H D' LW - Town or Village P,<rrEP-5rio
Subdivision name NfON�' Subd. Lot # Tax Ma ��
_U& Tax � Block
Date Subdivision Approved oil r�o Renewal Revision _
Owner /Applicant Name J0 I"" PMt'L -0 IbfLr-- o "Date of Previous Approval
Mailing Address 970j' K e i— bow 't _M�-- OY Zip
Amount of Fee Enclosed -! N
osQI
Building Typef-F-61 D EiKZ-45 Lot Areao % = No. of Bedrooms '� Design Flow GPD 00
Fill Section Only Depth Volume
Separate Sewerage System to consist of (p QO gallon septic tank and �l f
Other Requirements:
To be constructed by
Address
Water Supply: Public Supply From Address _
or., - k , ...Private' Supply Drilled by
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be co tructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Pu am County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfacto to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, is successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said 5 wa a treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the C ificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E. R.A. Date
Address SO �'� — 0 �Q� License # 5 ��
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system 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. Appr arge of domestic sanitary sewage only.
By: Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design P ofessional
Form CP -97
r
Ms. Virginia Denike
PO Box 162
Patterson, NY 12563
Dear Ms. Denike:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130 August 25, 1992
JOHN KARELL Jr., P.E., M.S.
Public Health Director
/� /ysyz'
RE: Residence Damaged by Storm
Denike - Corner of Albion Road
and Lake Shore Drive (T) Patterson
TM #27 -1 -9 & 10
On July 5, 1992, the above - mentioned residence was severely damaged by
a tree knocked down by high winds.
Apparently, the house was damaged to a point where the house must be
removed. The residence is served by a well located in the northeast
corner of Lot #1614 and the sewage disposal system is located along the
south side of the parcel.
Based on current code requirements, this Department has no objection to
the reconstruction of the residence with the following conditions
1. The residence must be reconstructed within the existing
footprint, if possible.
2. The total square footage must be equal to or less than the
original residence.
3. The total number of bedrooms must remain at the present number
(3 total bedrooms).
Approval by this Department is for the use of the existing sewage
disposal area and water supply only. Any other permits or variances
required are the responsibility of the applicant and the jurisdiction
of the Town of Patterson.
If you have any questions, please contact me at 278 -6130 x 168.
WH:mk
cc: BI (T) Patterson
Very trt_�y yours,
William Hedges
Sr. Public Health Sanitarian
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
January 16, 1991
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Ms. Virginia P. Denke.
Albion Road 8 Lakeshore Drive
Patterson, New York 12563
Res proposed addition:
Denke - Albion Rd. 8 Lakeshore Dr.
(T) Patterson
Dear Ms. Denke:
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:
A field-.inspection was conducted on January 14, 1991 by the writer. At that time
the outside dimensions of the house was measured to be approximately 20, x 30,
with a 8.5' x 8.5' room offset in the rear of the structure. There is a
significant difference between these dimensions and the existing dimensions
submitted.
Please contact this office, at your convenience, to address the above comments.
Ve ruly yours,
Robert Morris
Assistant Public Health Engineer
RM /jp
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
January 16, 1991
Ms. Virginia P. Denke
Albion Road & Lakeshore Drive
Patterson, New York 12563
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Re: Proposed addition:
Denke - Albion Rd. 8 Lakeshore Dr.
(T) Patterson
Dear Ms. Denke:
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:
A field.inspection was.conducted on January 14, 1991 by the writer. At that time
the outside dimensions of the house was measured to be approximately 20' x 30,
with a 8.5' x 8.5' room offset in the rear of the structure. There is a
significant difference between these dimensions and the existing dimensions
submitted.
-
Pleas e - -contact- -tti''s- office, at your convenience, to- address the above comments.
Ver truly yours,� %
Robert Morris
Assistant Public Health Engineer
RM /j p
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
(914) 225 -0310
7
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SURV R
E Y OF PJ)°ERT Y.•
-... f'REJ°Ari�LT•FDR .. - ;, ..
JAMES . BRENNAN
a r i ti BEING
Y, L OrS 16 11 - 16,15 INCL.
SHOWN ON
SECOND MAP OF. PUTIIIAM LAKE
SlrUArE IN
TOWN OF : PA T TERSOIV,
:.... • = PUTNAM COUNTY, NEW YORK .
TOWN OF . NEW FAIRFIEL D
FA IRFIEL D COUNTY, CONNECTICUT
., SCSI L E / 20'
Said mop filed Morch 20, 1931 os NO A10149-4
crone wall �--�
stone masonry wW1
pi Off penct — -- • - "
y wire fence — ,. _• _,—. :i f .
wires
rj. iron pin seI -- •
III d '// no /e set --- •:
I, tomes C. Edgetf the surveyor who mode ; ; AIM. A// cerfificolions hereon ore v.7 1id for IA is '
WS mop, do hereby certify Mot the survey mop and copies Inere,)f only if soli moo or
oftm property shown hereon wos completed..: - coves rsor the impressed se V of the :
Moy21,1969. s, vyor wboso signature appears hereon..
E ark License N93721?
Cc nn. Registration N956632
Of /ice of James C. "gaff
Land Survoyors
9.1 Moih Street Brewster New York JOB N96907
4.
�... .. BRUCE R. - FOLE ... < ......._ , ...., _ w .
Public Health Director
LORETTA MOLINARI R.N.;
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
May 3, 2001
Ms. Virginia Denike
PO Box 162
Patterson, NY 12563
Re: Residence Damaged by Storm
Denike - Corner of Albion Road
and Lake Shore Drive (T) Patterson
TM #27 -1 -9 & 10
Dear Ms. Denike:
On July 5, 1992, the above - mentioned residence was severely damaged by a tree knocked down by
high winds.
Apparently, the house was damaged to a point where the house must be removed. The residence is
served by a well located in the northeast corner of Lot #1614 and the sewage disposal system is
located along the south side of the parcel.
Based on current code requirements, this Department has no objection to the reconstruction of the
residence with the following conditions.
1. The residence must be reconstructed within the existing footprint, if possible.
2. The total square footage must be equal to or less than the original residence.- - - - - - -
3. The total number of bedrooms must remain at the present number (3 total bedrooms)....
Approval by this Department is for the use of the existing sewage disposal area and water supply
only. Any other permits or variances required are the responsibility of the applicant and the
jurisdiction of the Town of Patterson.
If you have any questions, please contact me at (845) 278 -16130 ext. 2168
.Very truly yours���______.
William Hedges
Sr. Public Health Sanitarian
WH/jp
cc: BI (T) Patterson
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130
JOHN KARELL Jr., RE, M.S.
Public Heeltti Director
Ms. Virginia Denike
PO Box 162
Patterson, NY 12563
RE: Residence Damaged by Storm
Denike - Corner of Albion Road
and Lake Shore Drive (T) Patterson
TM #27 -1 -9 & 10
t
Dear Ms. Denike:
On July 5, 1992, the above - mentioned residence was severely damaged by
.a tree knocked down by high winds.
Apparently, the house was damaged to a point where the house must be
removed. The residence is served by a well located in the northeast
corner of Lot #1614 and the sewage disposal system is located along the
south side of the parcel.
Based on current code requirements, this Department has•no objection to
the reconstruction of the residence with the following conditions _
-1. _ The .residence - -must -be reconstruct_ ed_.. within , "_the _'--e xxs irig'...:
footprint,-if- possible.
2. The total square footage must be equal to or .less than the
original residence.
- -3:- - The total number-of - bedrooms -must remain--at - the - -present - number -- -- - --- - ----
„ -_ total bedrooms ),
Approval by this Department is for the use of the existing sewage
disposal area and water supply only. Any other permits or variances
required are the responsibility of the applicant and the jurisdiction
of the Town of Patterson.
If you have any questions, please contact me at-278-6130 x T6�
Very trt ,y yours,
William Hedges
Sr. Public Health Sanitarian
WH:mk -
cc: BI (T) Patterson
It
r
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
Geneva Road, Brewster, New York 10509
(914) 278 -6130
JOHN KARELL Jr., RE, M.S.
Public Heeltti Director
Ms. Virginia Denike
PO Box 162
Patterson, NY 12563
RE: Residence Damaged by Storm
Denike - Corner of Albion Road
and Lake Shore Drive (T) Patterson
TM #27 -1 -9 & 10
t
Dear Ms. Denike:
On July 5, 1992, the above - mentioned residence was severely damaged by
.a tree knocked down by high winds.
Apparently, the house was damaged to a point where the house must be
removed. The residence is served by a well located in the northeast
corner of Lot #1614 and the sewage disposal system is located along the
south side of the parcel.
Based on current code requirements, this Department has•no objection to
the reconstruction of the residence with the following conditions _
-1. _ The .residence - -must -be reconstruct_ ed_.. within , "_the _'--e xxs irig'...:
footprint,-if- possible.
2. The total square footage must be equal to or .less than the
original residence.
- -3:- - The total number-of - bedrooms -must remain--at - the - -present - number -- -- - --- - ----
„ -_ total bedrooms ),
Approval by this Department is for the use of the existing sewage
disposal area and water supply only. Any other permits or variances
required are the responsibility of the applicant and the jurisdiction
of the Town of Patterson.
If you have any questions, please contact me at-278-6130 x T6�
Very trt ,y yours,
William Hedges
Sr. Public Health Sanitarian
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