Loading...
HomeMy WebLinkAbout0059DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15 -1 -12 BOX 1 ,ti s . rr NNN. 1 IN I T ,r T NN I I NJ IN ;} 1 -fts'l IN A 00059 k+ all 77;. ( - Rev. 3/86 PUTNAM COUNTY. DEPARTMENT OF:HEALTH Divlslon of Environmental Health Services, Carmel, N Y:10512 p �`•� F��l 2 Engineer Mast Provi de f%z P.C..H D.Permitp CER ATE OF CONSTRUCTION COMPLLANCE FOR SEWAGE. DISPOSAL SYSTEM �'.�'t'F St J Town or Village. Located at Tax Map 3:15 Block` Lot. Owner /applicant N Formerly � Subdivision Name i^ Subdv. Lot # Mailing Address F`—b �"A M �i,� i- l i✓Y 1� Y Zip i �� Date Permit Issued Separate Sewerage System built by TED Address Consisting of , co Gallon Septic Tank and :24-1 Water Supply: Public Supply From Address or: _ Private Supply Drilled by Address Building Type Has Erosion Control Been Completed? A10 Number of Bedrooms 2 Has Garbage Grind r,Been`Instslled? Other Requirements I certify that the system(s) as listed serving the.aboye premises, were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards; rules and regulations; in accordance with the filed plan, and the permit issued by the Putnam Couunty /•Department Of Health. Cate rG ! Z i Certifietl by _ Address j 9 i''ttc r'C tom= tV ( ®SI' License No. 91 Any person occupying premises served by the above system(s), shall promptly tike'such action as may be necessary to secure the correction :of any unsanitary conditions, resulting from such.usage. - _Approval of the separate sewerage system shall biicome. null and void,as soon as 'a pupt;z sanitary sewer becomes available and the approval of the private water supply shaII'become`nuil,and void when a public water Supply becomes evadable , Such approvals are sub)ect to odifirotion or change when, in'the judgment of the Commlisionar'oA. Health, such revocation, modification or than Is necessary. Cats — - 7L / / 3 T it 1. '>j WLLLL UUF1YLL'11U1V mrxuAi * * DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH` Office Use Only G /( l �l WELL LOCATION STREET AOURESS: WN/ I TAX GRID NUMBER: M0. WELL OWNER NAME: ADDRESS: rr C ACC.SSO0 : ,0- 5`� to �(Dhbl�tQ,1 14� ;) TO, RIVATE UBLIC USE OF WELL 1 - primary 2 - secondary 9LRESIDENTIAL ❑PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT — gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING [:]REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ❑ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH _ 4cs— ft. STATIC WATER LEVEL 21 0 ft. DATE MEASURED (9 `4-q3 DRILLING EQUIPMENT ❑ ROTARY R COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING 9 OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH _ �._ ft. MATERIALS: Q& STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: 10 CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT c2&-lb./ft. DRIVE SHOE: IA YES ❑ NO I LINER: Q YES (KNO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK 0 YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOD: ❑PUMPED t tests were done is in- t 69- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER i 0 YES 0 NO VELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water pear. ino Watt Dia- Meter in FORMATION DESCRIPTION woe ft ft. WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD 9pm. Land �f Q.� 4� L L ' t e ost�S` WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES ❑ NO STORAGE TANK: TYPE CAPACITY GAT.. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME " LOtM QQQ C� DATE ADDRESS P + S SIGNATURE (2% ,; -,,We l r_7 3/89 - l Us - -.Va C Irv: +R a Y NORTH AMEMCAN ANALYSIS DATA SHEET TYPE: PW LOCATION: Lot #7, Sapling, Court, Patterson, NY REPORT TO: McGlasson Realty Inc. ADDRESS: PO Box 610 CITY, STATE, ZIP: Carmel, NY 10512 DATE COLLECTED: 06 -08 -93 TIME COLLECTED: 8:45 AM COLLECTED BY: Edward McGlasson REPORT DATE: 06 -10 -93 SAMPLE: 93 -2364 SAMPLE SOURCE: Kitchen tap DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform MF Absent SM 17 (9215D)06 -08 -93 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS. tory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914- 278 -7600 / FAX 914- 278 -7754, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES USSl...1E, KtNC.,A eT Owner or Purchaser of Building 'TED nc.GLi&,sSp� Building Constructed by e;k&PL -1 N1CA GA 1.1 e- t' Location - Street JPAtt -?-GoN Municipality Building Type 3.15 1 12 Section Block Lot 1"tAPa...k. MOOD , Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his 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 disposal system, or any repairs made by rr8 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 Director of the Division of Environinental Health Services 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 �ldi ngutilizing the system. ii // n Dat 71 da of D 19 Signa Title General Co actor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Address ter. - rev. 9/85 mk F PUMAPA 000NPY DZFAnMMr OF MALTH DhWw ¢ SwW Hav16 Saefrlose. Cliasel. N.Y.,1�61?, &tpdMer to Piar We lw�lt /. w CERMFICATW.OF CO P> FOR WAM WSlKWa SY$!�1[ ° SW Impaled ,� 1,� Nla Feu Town - or vule" S>,- — - - u xaule Subll Lit r - _1 Tax Map L • Bloa O..atr /A�prea.t N... LXfJLI �► N G1��,i >:elb.nl- O ievkdeu o _ Date of Peevfoae Approval_ Lot Am. O A�•�1w�`�w��G Dead Flow G P D Sepeeate Sewsia w Synth to emodd d Al2-120 Gallas Sep* Tank oW "7.©l L • f • C2r G V�J � �'� 10 t•? to be onalreetod blv l.IN yNOYV tiS Af4he.a_ f—Itii K1�gOY�i I� Water Sslply: Pebble Supply Foes Address _Pdivate Supply Dyed W1_0 • w IMIAM211M ' _MMMM� 1 represent that) am wholly and completely responsible for the design and location of. the proposed system(s); 1) that the $operate sew di cal stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a ►egu ens o ham County DepirtmMlt of Health. and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department. and a, written guarantee will be furnished the owner, his successors, heirs or, assigns by the builder, that said bulkier will via" in pod operating condition any port of .said : swage disposal system during the period of two (2) years immediately following the date of the iseu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled wail deuaeaed allow wW be located as shaww.on the approved plan and that said well will be installed in accordeh a with the standards, rules and rpu TWn of the Putnam County Departmes Of Meelth. Date — Address � ��- t..9 P`i • license No C-1219 -11 APPROVED FOR CONSTRUCTIONI:TMS ap ., va carp twd�y/aPS'frb h i swed'U, constiuction of the buiWing.Ms been undertaken and is revocable for Cause or may be amemae0 or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a now permit. Approved for disposal of domestic unitary. ��e. dr (yr private water supply only. ��88 Wto � �` get —�� Title .: !'UM M ODUPM DWAn M OF MAWS . DNl�iw d ���ta1�1 BM11� 8ae�lew.'�t. N.Y l�Sl? CCRTMWATZ Of M >vbrMtU Wco ill tits anq of tow Will be locot revocable for riONN�t r»w,..i 10/88 parata'fawa • Aif OYL ttam rpu onf o , a u Mm . J � Commiul'iw'armeaKOwm ; www vs•w �•�w- II AalrJlba0 p6ora, 'Aho _ P11tMm- R.A. ass, conttiuction of�tha building his been undertaken and is aiOMr ;of.MNlth. :., Any` bhmnYe':br iRMiltion, Of conitructbn watts tupVtY oMii.. � . Ta' PJII'M CC(J'LTfY DEPAYM -0-Ir OF Y:cAMM DIVISION OF ENVIM:M1ML ;HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE .A. Owner -E -�E KfNC�FL�t Address ps-11t4,6.M y � Y �5, 9 Located at (Street) ►P1-et a C&*-S -t Sec. '-51NS Block Lot 2 (indicate nearest cross street) r�uu cipality PAitZ __. 'Watershed . C.R0141-4- Date of Pre - Soaking '+19-711'175 Date of Percolation Test HOLE 8 24 T1 3 NUMER CLOCK TIME q PERCOLATION eL7 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 1 to�32 -10�3� 4 24 V) 3 2 10•.36 - 1 0•41 5 24 3 5 24 3 2 4 10" 41-.1 O =S3 % 5 i 1 10: 3`l - 10= 3b `1' 24 d 27 3 2 10= 3' - 1D'+,-S- 6 24 3 lo: 53 8 24 T1 3 3 4 '�o:s3 - le'o2 q 24 eL7 3 3. 5 1 2 3 4 5 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 from top of hole. rev. 9/85 DEPTH G. L. 1' 2' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' TEST PIT DATA REQ(iI= TO a" SLii�4ITTF:D WITH APFLI CATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUNDMTER -IS ENCOUNTERED' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ` DEEP HOLE OBSERVATIONS MADE BY: ''DATE DESIGN Soil Rate Used 0 ', Min /1" Drop: S.D. Usable Area Provided 2;1 No. of Bedrooms 2• Septic Tank Capacity I000 gals. Type ca`� Absorption Area Provided By �a L.F. x 24" width trench �cP��OF tdEW C�. Oder c c ? J. COrV >,, ' fi Name PMI%41 PAZignature s' Address 1 °) Rcu -m <y SEAL 1E, iJ'{ FEScO THIS SPACE MR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft/gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town/Village/City Tax Grid Number - ('i — t _ Z �� WELL OWNER Name Mailing Address a7rivate O Public .USE OF WELL 1 - primary 2- secondary a'RESIDENTIAL 13 BUSINESS 0 INDUSTRIAL 13 PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP 0ABANDONED O FARM O TEST /OBSERVATION p OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED% _ /EST. OF DAILY USAGE 3oy Sal REASON FOR DRILLING O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GI ADDITIONAL SUPPLY ARIIEW SUPPLY NEW DWELLING [3 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE E3�RILLED DRIVEN DDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS" LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 1 WATER WELL CONTRACTOR: Name Address : Lt� sY-i- "3 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETG11 A SOURCES OF CONTAMINATION PROVIDED / i ON SEPARATE SHEET 6o I /GZ. (date) ig ure) I 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 thirtir (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 other�,e contaminate surface or groundwater. Date of Issue: 19 i Date of Expiration 19 Permit Issuing Of icial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PC -1 PUTNAM COUNTY DEPARTMENT OF' HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: LOSU 6 2. Name of Project: � ��i`� &If LG��PLAL 1��NG�12-� -3. Location T /V /C: e^A [e-(na i 4. Project Engineer: 5. Address: i 4�'l fayff� Co License Number: 19 Phone: ZZ� -�o2c 1C��1'L 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) T. 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? ............. P-}O 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency _alb" 11. Is this project in an area under the control of local planning, zoning,: orother officials, ordinances? ......... ............................ 12. If so, have plans been submitted to such authorities? .................. 1l� 13. Has preliminary approval been granted by such authorities? Date Granted: N A 14. Type of Sewage Disposal System Discharge...... Surface Water , Ground Waters 15. If surface water discharge, what is the stream class designation ?........ V 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. 18.' If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... t-� 20. Name of sewage system o-;�A Distance to sewage system 21. Date observed: 1 0 23. Name of Health Inspector: 24. Project design flow (gallons per day) .... ............................... 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. (�Cd 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? .................................. ............................... f-3 CP 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? .............. ............................... t-_�� Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... (ten 31. Is or was project site used for agricultural activity involving application of pesticides 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 NO tad DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ............ PJN IO 34. Are community water, sewer facilities planned to be developed within 15 years? uN N 3 .:4ny "sewage disposal areas in excess of 15% slope? .......................4�? Ao Tax ...'Map x�'ID Number ........................... ................... ......�J.iS- 37.:_ Approved Plans are to be returned to: ................ Applicant Engineer If the- application is signed by a person other than the applicant shown in Item 1, the appli'catfbn 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 knowledge and belief. False statements made herein-are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 7 Law. L SIGNATURES & OFFICIAL TITLES: N t�G HAILING ADDRESS: DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 Attn: Bill Bricklemeyer Insight Engineering and Design, P. C. 1849 Route 6 Carmel, MY 10512 Dear Mr. Bricklemeyer: ._S� JOHN KARELL Jr., RE, M.S. Public Health Director June 15, 1992 Re: Construction Permit Application for Single Family Residence Leslie Kincard - Sapling Court, Maplewood Lot #7 TM #3.15 -1 -12 (T) Patterson I have received and reviewed the plans for the sewage disposal system and individual water %apply on the above mentioned lot. 1.fThe sewage disposal system requires the placement of Run of Bank fill to a depth greater � than two feet. Therefore the construction plans should show the fill section only. _2 ;-- The drawing should clearly show the length, width and depth of the fill section. _3.,__. The standard fill notes are lacking. The location of grade stcpks must be noted. 5: 'Note 10 is insufficient. Crossill4 grading from lot #6 to lot #7,must be required, or the plan must show 10' separation from the ends of the trench to top of slope and a 3:1 minimum to toe of slope. 6. The expansion area is shown.within the drainage easement to the west. 7. All restrictive distances, i.e., 100' to existing well to the south, 50 feet to catch basin must be from the toe of slope of the fill section. S. The well to the north (lot #8) is not shown. 9. The well to the west (Mulrizio) is not noted as an estimated location. A more precise location is, required 10. The Mulrizio well and the well on lot #1 may be considered within direct line of drainage. Therefore, a minimum of 200' separation may be required. 11. Although the lot was created after 1969, the size and location of these parcels will require a letter from the Building Inspector, Town of Patterson, and standard neighbor notification, re design, including the above mentioned comments, may generate additional concerns. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges Sr. Public Health Sanitarian WH /Jp till � iii- � .�Ir �'�1■ -����� �_ �/�`J i . ..... ..... 11 0 0 PC -1 PIJTNAM COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 1,052>L' b V-ir� -A�� ZCo nJiN1y���o �.�.C7 Pc�-� NA�''l V,a.LL,�Y, r-s•Y. �o� —lei 2. Name of Project: �- -� i � =L1� V'fk 3. 'Location T /V /C: 4. Project Engineer: 5. Address: C-cxAe C�-, • G��M�I., A-��W Yo�K 112 License Number: t9--:5i Phone: 6. Tvge of Project: Private /Resident Apartments Office Building 7. Is this project subject Type Status (Check One) ial Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) to State Environmental Quality Review (SEQR) ?. Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ..... :....... t-�o 9. Has DEIS been completed and found acceptable by Lead Agency? ........... N /sue 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, Lt-),ric5l or other officials, ordinances? ........................................ Fi � 8LLCK'r of 12. If so, have plans been submitted to such authorities? .................. t-� 13. Has preliminary approval been granted by such authorities ? t-�4, Date Granted: t-�/A 14. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ N %. 16. Waters index number (surface) ................................... :...... LA 17. Is project located near a public water supply system? Nb 18. If yes, name of water supply N;% Distance to water supply -- F =��t`' 19. Is project site, near a public sewage collection or,d.isposal system ?..... !�'o 20. Name of sewage system Distance to sewage system 21. Date observed: 1 /10 2: 23. `Name• -,of. Health1.Jnspector: 24. Project design flow (gallons per day) ........ ..............................� 0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. tav 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? ..... ............................... ............................. cam 28. Wetland ID Number ......................... ............................... 7' /lam 29. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. t-V6 -- 30. Does project require a DEC Stream Disturbance Permit? ................... t-54Z:> 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO N� 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 tNG DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 0ri,bVJ0 34. Are community water, sewer facilities planned to be developed within 15 years? uN Knbhia.➢ 35. Are any sewage disposal areas in excess of 15% slope? ....... •��`'►-t�� 36. Tax Map ID Number ......................... ............................... '3 37. Approved Plans are to be returned to: Applicant K_ 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 knowledge and be 1 ief. False statements made l�r6rein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of V!f; -tithe Pena 1 Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: p'f"'.' J::a,.:��•., +�/.. ,rte' CZi Ca co w `.. !r, ,OT. l rFf •� � 1 "'1 C1 t. ��;��i/s "��j { ` �`. _ •. 1 �' , tip I �� •• 1� '1 .�1'. !• ' . f `tj r�r { Ul D .HE . 3 fiti , x ��� � 3'15 ;; °'; *.. ,,, !�, a ` � •+ , o C -w 1 . PU11 M COLRII'Y DEPARTMENT MENT OF HEALTH DIVISION OF HEALTH SERVICES DESIGN DATA SHEET— SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. !_ � K Gc isLj� L�73L�C C� ACA 44 Owner LPL. /M INI % Address Ae,—, ,e ,, r��? � �. [.xl A- �' le)6 `7 Located at (Street) il7- Sec. 3./� Block r Lot (indicate nearest cross street) Municipality AA Watershed SOIL PERCOLATION TEST DATA PIWIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking /0 7 Date of Percolation Test a �% HOLE NLEBER 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 1 &!OF - /1-77 41���'3 �l'.>y� -'rte 5 1' ,OL�Sfdr/t� ✓r"[C ec�r /off �.tl� OTC 3 F"r� �ts9� Ila 4 5 NOTF,S: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal.soil rates• percolation test hole. All data to'be submitted be made from top of hole. J 5 41���'3 �l'.>y� -'rte 5 1' ,OL�Sfdr/t� ✓r"[C ec�r /off �.tl� OTC 3 F"r� �ts9� Ila 4 5 NOTF,S: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal.soil rates• percolation test hole. All data to'be submitted be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. ,0 % HOLE NO. 2— HOLE NO. G.L. 1' 2' 3' 4' 5' 6' 7' s' 9' 10' 11' 12' 13' 14' Act e' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: Al. DATE: �. DESIGN Soil Rate Used 0-7 Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 10 oo gals. Type Absorption' Area'- Provided By O o - -L.F. x 24" width trench `U ,, * -f Other �° Name 4� Signature Address 19W 6' SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date SENDER. _ • Complete items :1 and /or 2 forradditionai services • Complete Items 3 $nd 4a,& b - = I also WISht ,t0 rBC8IV8 th8 .r following services Ifor an extra'° • Print your name and address on the reverse of this for;io that we c "an , 'you fee) - return this card to • Attach this form to the,front of the mailpiece, or on the back'If space 1 Addressee's Ai dross does not permit.. > , ;. • Wrrte''Retum Receipt Requestetl on the mailplece below'the article number 2 ❑ Restricted D eliv,6ry •- The Return Receipt Fee will pro4ide you the signature of the :person deli4ere , to and the date of delivery. - COt1SUlt 08tm8Ster: for fee:.' - 3 Article Addressed to 4a i N�urnber ffe 4b = ervice Type Re ieterfsd ❑'Insured BNal . ❑Return Receipt.for ❑;Express ii Merchandise ' 7 Date Qate of4 eirvery ) , i nature (A'ddre ee) k�"I" 8 ,ddressee` re nly if, reque;ted. -- rid -fee is paid) gnature (Agent) G PS Form 381 1 November 1990 *us'oao 190 ze7a(l DOMESTIC RETURN RECEIPT> .` r - e i SENDER: ; • Complete items 1 and /or 2 for additional services. I also wish -.t0 receive the • Complete Iteme 3, and 4a" & "b. _ - following services (for an extra ; • Print: your name and_addiess on the reverse of this form so that we can fee) return•this derd to you' , • Attach "this form to the front of the -❑ mailpiece,:or on the back if space 1 Addressee's Address does not permit: i • .Wri te' 'Return Receipt Requested -' on the mailpiece below the article number'.'.- 2. ' O RBStrlCted -Delivery 4 • The?Returri RecelptFee will provide "you the signature of the person delivers ,to and ttie'date of; delivery. Consult p6stma ster for fee 3 `Article Addressed to 4 icle Nu ber 4b rvice TyQe LCIL egistered ❑' insured ertified ❑COD ❑ Express Mail ❑ Return Receipt for, ' °r on Merchandise ".� ti ,�.� �C• 7.' Date of Delivery 5 Sign ture (Addressee) 8 A as e Address" (Only If requested and ,fee is _,paid) nat e- (Agent)' ' °i PS Form: ..38 11 , :November. 19.90 10.s: GPO:101 ;;ze� QpME$.T.IC_ RETURN. RECEIPT SENDER: - Complete _items 1 and/or 2 for additional services. I also wish t0 receive-, the •Complete "items 3, and 4a; &b: =. - following- services -(for: an extra Prinf your name'snd address on the reverse of this form so that we can . fee)s return thiscard to you. pp J * -Attach this -form to the front of the mailpiece, or on the back if space - 1 ❑- Addressee's - Address =_ do 'permit l' 1 •Write 'Return Receipt Requested'' on the mailpiece below the article numbers 2_0 -­ Restricted Delivery • The Return Receipt Fee will provide:you the signature of the person dehvere io.andJhe date of delivery. `Consult ostmaster for;.fee. . 3 Article Add ressed to z 4a iclq' Number i'� i 1 ` 4b Service Type` :. egistered "' =' '❑ Insured l Certified COD ❑Express Mail ❑ Return Receipt for". Merchandise_ '. w 7 Date of Delivery ige (Add ssee)� `+ N `8 Addressee s Address (Only If, requested andIee Is paid) 6 Signature (Agent) 3 PS Form 1 , - November 1990 -i�,-� . d -0:1991 -287 -M DO_ MESTIC RETURN RECEIPT . INSIT�4 &NDESIGN, NP. C. Date -7 - a - `12 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: LcsLiE KtOCART Address: SAPL1t-1Ca CpurZT_ Town: PAl•TF_KeC 4 Tax Map: 'S. 15 - � - jZ- Dear M?,. I RG.D tov MR5. LA UtC.R Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed f or the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the 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 hh=U=zh of the Health Department at (914) 278 -6130. Very truly yours, INSITE ENGINEERING AND DESIGN, P.C. By: Jef r y J. elmo, P.E. Principal Engineer RECEIVED BY: Address: Tax Map: (Please sign and return in the enclosed envelope) 1849, Route 6, Carmel, New York 10512 (914) 225.6200 n - r14 e,�,,o Wahhinyers Falls. New Ya4 r25oo, (914) 297-1742 INSITE-- &NDESIGN,NP. C. Date -7 • lb • �\Z RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Lf-G U E KINGART Address: SAFi -k � LouRT Town: PATrt =Rsvtil Tax Map: S.15 - Dear l"IR. WILLkAM v4c> MRS, 1Rl—=t"C Woop r' Please be advised that an application for a Construction Permit 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 site plan. If you have any questions, concerns or inf ormation which may bear on the Health Department's review of this application, you may call Mr. Hedges or of the Health Department at (914) 278 -6130. Very truly yours, INSITE ENGINEERING AND DESIGN, P.0 By: Je re n mo, P.E. Principal Engineer RECEIVED BY: Address: Tax Map: (Please sign and return in the enclosed envelope) Rr 1849, Route 6, Carmel, New York 10512 (914) 225.6200 n.r Ar 1V7rthhin7Prs FaIIs. Ne�, YrnG 12500 (9T4) 297-1742 . INSIT&-O &NDESIGN,NP. C. Date -7 • 6 • 11- RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: LEG U E KIOC ARN Address: SAPL.It�1C_1 �� -►►�T" Town: PATT�KSOt.1 Tax Map: 5.15 - Dear M� :�Al'ICS N. ANp l"1R5. MAUFtc�� j , Gp�tZPt NTEP� Please be advised that an application for a Construction Permit 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 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 bftsMmzd3 of the Health Department at (914) 278 -6130. Very truly yours, INSITE ENGINEERING AND DESIGN, P.C. By: �J Jef e o lmo, P.E. Principal Engineer RECEIVED BY: Address: Tax Map: (Please sign and return in the enclosed envelope) V1849, Route 6, Carmel, New York 10512 (914) 220200 n - ►"1„1 d.wvv lxlnhhinnv+o Fnlic )tivu. Y - -G t�cnn (OCA) 207.17d2 INS I TE & DESIGN, NP. C. Date -1 - g • 9Z RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: A05EPN Kk06ARTI t_.ES� -tE YW -X KT Address: SAPL►N(a f4XvKT Town: PATTF-KSz>V4 Tax Map: 3,%S- 1 - i 1 -j 3•�5 1 "tZ Dear MR: FlAlt -1P .moo MRS. ELUtSE fUF,,CC,LL� Please be advised that an application for a Construction Permit 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 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 orris of the Health Department at (914) 278 -6130. Very truly yours, 1NSITE ENGINEERING AND DESIGN, P.C. By: .1 1 Je` . tontelmo, P.E. Principal Engineer RECEIVED BY: Address: Tax Map: (Please sign and return in the enclosed envelope) fd 1849, Route 6, Carmel, New York tosra (914) 445-6200 IV?- .,;__.._. •►,.,.v,_t. fo►el 207,1744 INSI TJE=4 &NDESIGN,NP. C. September 3, 1992 Mr. William Hedges Senior.Public Health Sanitarian Putnam County Department of Health Geneva Road Brewster, New York 10509 Re: Fill Permit Application for Single Family Residence Leslie Kincart, Sapling Court, Maple Wood Subdivision, Lot 7 Tax Map 3.15 -1 -12, Town of Patterson Dear Mr. Hedges, In response to your letter dated June 15, 1992, we offer the following comments: The fill drawing shows the fill section only. 2. The fill section on the fill drawing is dimensioned. The standard fill notes are shown on the fill drawing: 4. Grade stakes have been shown on the fill drawing. Note 10 on the construction drawing and note 8 on the fill drawing state that if the required fill for lots 6 and 7 is not installed simultaneously, the fill shall be brought to the lot 6/7 lot line and then graded off at a 3 on 1 slope onto the adjacent lot. The easement for this cross grading onto the adjacent lot will be forward to you when available. 6. Please see the attached letter from the Town of Patterson Building Inspector. 7. It appears that this comment refers to lot 6. 8. The well to the north (lot 8) is shown. 9. Our office has researched the location of the well to the west on the Mulrizio property and has not been able to locate a more precise location. It appears that at the time this lot was created the well was not able to be precisely located either (see enclosed copy of original integrated plot plan). The location of the well as shown on the map is the best estimate that we can provide. 10. The proposed SSDS is in the general area as approved by the Putnam County Health Department with approximately the same separation distances (see filed map 1166). 11. A letter from the Town of Patterson's Building Inspector is attached. Copies of the letters sent to the neighbors are enclosed as well as the return receipt cards. r849, Route 6, Carmel, New York 105r2 (914) 225.6200 O 7 DeLa.vergne Avenue, Wappingers Falls, New York r2590 (914) 2971742 Fax: (914) 225-6438 o- The. surveyed location of the rock outcroppings on the property have been added to the plan. A copy of the original intergrated plot plan showing the approximate location of the Muirizio well is enclosed, as requested. by Jack Karrell on July 21, 1992. Should you have any comments or questions concerning this.project, please feel free to contact our office. Very truly yours, INSITE ENGINEERING AND DESIGN, P.C. JJC /WJB /mth cc: Leslie Kincart Insite File No. 91137.307 17-0 e--y- ILI L rev? O Kt LD 144 to 14 ti (I w Lt) I 51A. ip DRY 77 /Z N, X Lot 4 A �/F r�t�i 1Rf7�n TSB SAPI- II --tC� Crx�Ri- TERATTON OF THIS DOCUMENT, UNLESS UNDER THE DIREC77ON _ A LICENSED PROFFESSIONAL ENGINEER, IS A NOLADON OF 'CTJON 7209 OF ARTICLE 145 OF THE EDUCATION LAW. Lo � 4j4 & AS -BUIL T MEASUREMENTS .NO. A B REMARKS I �{D� 5!' ICX0Gil�L.'b.t. 2 93` 71' Dist. - 5CK 102' ` E. -JO bRE.10 -4 4 76 RECORD OWNER: L E5LjF- Kih- �C:15►R 240 t�►lt -�d Ro�P R1t VJ�t- uY 106779 TOWN OF. P�tt�RSor.1 PUTNAM COUNTY, NEW YORK TAX MAP NO. NO TES: I. THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONS7RUC7ED AS INDICATED ON 77-IIS PLAN AND THAT 7HE SYSTEM WAS INSPECTED BY INSITE ENGINEERING AND DESIGN, P.C. BEFORE IT WAS COVERED OVER. 77-IE SYSTEM WAS CONSTRUCTED 7N ACCORDANCE WITH ALL STANDARD RULES AND REGULA770NS OF 77-IE PUTNAM COUNTY DEPARTMENT OF HEAL 7H AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2 ALL FACIL177ES EXIS77NG, UNLESS NO7ED 077-IERWISE J. TOTAL LENGTH OF FIELDS REQUIRED TOO L. P, TOTAL LENGTH OF FIELDS PROVIDED 2,OC I-F, 4, Houc.+E; �tGfl 1!,4 I JEt-L w ,Ntloj PRoPERt-f eou-lo�Y p4jo / o�t�NCFF� H FRc: l 6�.IR`s( E REO 5- RIGR,&90 H. C}oR2K, Ls. 04-t'EP 2/11/91, AND 5WLr4Hl 10 tt;e &1I5A5,