Loading...
HomeMy WebLinkAbout0077DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.16 -1 -1.3 BOX 1 J j "6 1�' ' 00077 �r 00077 Owner /applicant Name dA4 -92 R —Formerly Subdivision Name Subdv. Lot M Mailing Address- 39 WATFRM -T.UN ATT_T. 2n Maunper ZIp` 1 0541 Date Permit Issued 717 /•93 Separate Sewerage System built by STFVFN SAT.ANTTNn Address 121 E HICKORY BEND, CAMEL; NY Consisting of 1700 Gallon Septic Tank and 300 LIN= FEET OF 24 INCH WIDE TRENCH Water Supply: Public Supply From Address or: X Private Supply Drilled by NORMAN ANDERSON Address 1552 .BARGER ST'. PUTNAM VALLEY, NY Building Type 1.5 STORY FRAMED HOUS as Erosion Control Been Completed? YES Number of Bedrooms 3 Hear Garbage Grinder Been—installed? NO Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as a on the plans of the completed work ( copies' of which are attached) , and in accordance.with the standards, rules and regulationa, in accordan sh d 'lan, and the permit issued by the Putnam County Department Of Health. Date Nov.. 2, 1995 carrried try P.E. X R.A. Address B X 37 -B STE 10509 I_icenae Ito. 051011 Any ,person occupying premises served by the above systems) shall promptly take such action :aa may be noces"ry to secure the correction of any unsanitary conditions resulting -from such usage." Approval of' -the separate sewerage- sewerage• become null and void as won as a pubrz unitary .sewer becomes available and the.approval of the private water supply shall become null and ;6okf when a public water' supply becomes available. Such- approvals are subject to modificstl or change when,. In the judgment of the Commissioner -of �yah're _ [on, modification or change Is necessary. Date ' S , Title .,; , Oral,- CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 95 -6610 CLIENT: James Grundman 32 Watermelon Hill Rd Mahopac NY 10541 SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: DATE RECEIVED: DATE OF REPORT: Hose bib: Lot 3, Lisa Ct, Patterson NY J. Grundman 10/23/95 TIME COLLECTED: 11:30 AM 10/23/95 10/25/95 ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent Must be "Absent" Colilert 10/23/95 E. Coli Absent Must be "Absent" Colilert 10/23/95 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ✓ ACCEPTABLE. NOT ACCEPTABLE. Laboratory Director NYS ELAP #11218 CT Lab Approval #PH -0171 *Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 / 914 - 278 -7600 / Fax 914 -278 -7754 sA��I. s A1.mT TTTA11 TTTIATIT Gl- ,- •�/l ` �IO� - .W LOLL I�Vl'1r Lr, 11VL4 L\Lr VlXl DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only / .4r�, — WECti�:,OCATION STREET A00RESS: TDWW_WLAC411CIIy TAZ GRID NUMBER: LISA COURT 316 WELL OWNER NAME: ADDRESS: JAMES F. GRUNDMAN 32 WATERMELON HILL RD. MAHOPAC, NY PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary )9 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRICOND. /HEAT PUMP O ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) O INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT, -ff USE f s% YIELD SOUGHT � gpm.lNO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON`-FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY RNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL T� ft. DATE MEASURED -� DRILLING EQUIPMENT )440TARY O COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING XRPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH , 2 ft. MATERIALS: 1QSTEEL O PLASTIC D OTHER LENGTH BELOW GRADE �_ ft. JOINTS: O WELDED KTHREADED ❑ OTHER DIAMETER in. SEAL: ji� GEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE)?�YES O NO I LINER: 0YES MO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH. (it) DEPTH TO SCREEN (It) DEVELOPED? FIRST 6 *S O NO a HOURS SECOND GRAVEL PACK 11 NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH —ft. BOTTOM DEPTH It. WELL YIELD TEST If detailed pumping :< METHOD: ❑ PUMPED tests were done is in- -COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; O YES O NO YY �LL LDG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear. ing well Dia- meter In FORMATION DESCRIPTION qoE It ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN (t YIELDH 9Cm Land Surface t /, QUALITY ❑CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO NALYSIS ATTACHED? O YES O NO FMAKFR ❑CLEAR TEMP. STORAGE TANK: TYPE CAPACITY GAL. INFORMATION CAPACITY DEPTH VOLTAGE HP WELL D�I,LfFR NAME DAT ADDRESr Y SIGMtM G 4� 0- J/ VJ PUTNAM COUVEY DEPARTMENT OF HEALTH DIVISION OF 'ENVIRO`D*=AL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot �OPP Building Constructed by ­LOcat on - 'Street Subdivision Name Municipality Subdivision Lot # 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 we 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 Environmental 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 of the building utilizing the system. Dated this day of 19 Signa % Title ;e:raal.Con ctor (Owner) - Signature kA, Corporati n -(if Corp.) "Address 7 rev. 9/85, Ilk a� i J Address or C �/ J. R. FOLCHETTI & ASSOCIATES ENVIRONMENTAL ENGINEERS 98 Mill Plain West P.O. Box 374 1849 Rte. 6 Danbury, CT 06811 Brewster, NY 10509 Carmel, NY 10512 203 / 790 -6445 914 / 279 -3346 914 / 225 -1510 203 / 792 -2092 FAX 914 / 225 -1704 FAX TO: PUTNAM COUNTY HEALTH DEPARTMENT GENEVA ROAD BREWSTER, NY 10509 WE ARE SENDING YOU • Shop Drawings • Copy of letter ZIT. 7MER (37 7RA.N OME1UPTAIla DATE: 11/6/95 JOB NO: 95 -045 ATTENTION: MICHAEL BUDZINSKI, P.E. RE: LISA COURT LOT 3 PATTERSON, NY 11/2/95 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYS. 1 N Attached ❑ Under separate cover via r,dl 'Oel►ver t the following items: • Prints ❑ Plans ❑ Samples ❑ Specifications • Change order ❑ COPIES DATE NO. DESCRIPTION 1 11/2/95 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYS. 1 11/2/95 OFFICIAL CHECK FOR $100.00 MADE PAYABLE TO PC DEPT. OF HEALTH 3 11/2/95 GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM 1 WELL COMPLETION REPORT 1 10/25/95 CERTIFICATE OF LABORATORY ANALYSIS THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE REMARKS: • Resubmit ! copies for approval • Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US Jvr,�v COPY TO: FILE SIGNED:° Q J. ROBERT FOLCHETTI & ASSOCIATES ENVIRONMENTAL ENGINEERS J. ROBERT FOLCHETTI, P.E., D.E.E., Principal WILLIAM J. McGIMPSEY, P.E., Senior Associate Mr. Michael J. Budzinski, P.E. Senior Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 November 28, 1994 RE: REISER - GRUNDMAN SUBDIVISION, TOWN OF PATTERSON Dear Mr. Budzinski: In accordance with the approved plans for the referenced project, the requirement for drains around the leach fields was evaluated at the time of construction. This was accomplished through evaluation of water levels in the perforated stand pipes between October 25, 1994 and November 14, 1994. Per our telephone conversation on November 14, 1994, both JRFA and the PCHD are in agreement that drains around these leach fields are not required. Please advise if you have any questions. Very truly yours, J. E. Folchetti, CHMM JEF /jmm cc: J. Grundman File ® 98 MILL PLAIN WEST ❑ P.O. BOX 374 ❑ 1849 ROUTE 6 DANBURY, CT 06811 BREWSTER, NY 10509 CARMEL, NY 10512 203 - 790 -6445 914 - 279 -3346 914 - 225 -1510 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 October 25, !994 Mr. J. E. Folchetti 90 Mill Plain Wgsr Danbury, CT 06811 Re: Reiser- Crundman Subdivision (T) Patterson, Dear Mr. Folchetti: P- JOHN KARELL Jr., P.E., M.S. Public Health Director As a follow up to our telephone conversation of last week, it was agreed by you and this office to install perforated standpices Cr piezoneters to monitor groundwater levels on lots #1 and 3 of the above referenced project. This Department is to be notified when the pie= ome:srs are installed. Kindly advise us if there are any questicns. MJB /jp Very t:.: i y yours, Micnae J. Eudzin'ki, P. E. Sr. Pubic Health c- ineer 0 :- J. ROBERT FOLCHETT9 & ASSOCIATES ENVIRONMENTAL ENGINEERS J. ROBERT FOLCHETTI, P.E., D.E.E., Principal WILLIAM J. McGIMPSEY, P.E., Senior Associate October 17, 1994 MEMO TO: Mike Budzinski FROM: J. E. Folchetti'¢zr--t SUBJECT: REISER - GRUNDMAN SUBDIVISION 1. Per our telephone conversation on this date, the owner of the referenced subdivision desires to evaluation the requirements for curtain drains around the SSDS's for Lots 1 and 3. This is in accordance with the approved plans. 2. As we discussed, the re- evaluation will take the form of test holes, to be dug after the next rainfall. The excavations will be inspected by yourself or a PCHD representative. 3. JRFA will remain in contact with you to confirm the adequacy of the next rain event and to schedule the excavation. 4. Should you have any questions, please do not hesitate to contact me. JEF /jmm cc: J. Grundman File 98 MILL PLAIN WEST ❑ P.O. BOX 374 ❑ 1849 ROUTE 6 DANBURY, CT 06811 BREWSTER, NY 10509 CARMEL, NY 10512 203 - 790 -6445 914 - 279 -3346 914 - 225 -1510 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Camiissioner of Health - FIELD ACTIVITY REPORT - ADDRESS -/ C'-- ` No. Street Town ZNl No. MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE 141"WeX I �•e • • �• VDITI Dig Sheet / of/ _ Orig. Routine _ Orig. Complain _ Orig. Request _ Ccanpliance _ Complaint Carp _ Final _ Group Illness Construction _ Reinspection _ Field, Sampling Only Field Conference _ Other DATE Q TYPE FACILITY TIME ARRIVED U 3-D TIME LEFT j 2 FINDINGS: Explain ,V, INSPECTOR: and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: r *re.� ❑ bwltia. ❑ O.moldAS bont.— James Grundman Daft d Previte Appaievd MriOAAiwr 469 Watermelon Hill Road Tom Mahopac np 10541 Date Subdivision Approved PCHD — 6/9/89 Fee Enclosed ❑ Amn„nt NA- Paid PPB - 9/27/89 Subdi I vision PR �� a Residential la Ate. FE Sedhe 01114 DW& . VOWme tAnw .w d 3 Deaiiip raw G P D 600 PM PI WIN n- 18 284shwl wbem PBl Y aspbtlad 5"MANSetwn053 fdlsreenmd 1000 gdSgp&T" -A 300 LF by 24" wide trench T,b;ewsk dedby Not selected wow frts AfWes on X mr'fafNI M 110 00" byNni- SA l on+-�ess Olbar>lealiesull 205 LF of 3r ai n Arai n f-n ha i nstallerl 1 represent'ahat 1 am wholly and completely responsible for the design and location of the proposed sydem(s); 1) that the separate aaw di $ai stem above dmcribod will be Constructed as shown on the approved amendment thereto and an accordance with the standards, rules a rasa ns m County Department of MORI% and that on completion.thersof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Halthwill be submitted to the Department, and a written guarantse will be furnished the owner. his sucessaws. heirs or asayns by the builder, that said bulkier will Peep ih pod .operaatkig GNMRion. any part of said awala disposal system during the period of two (2) years lately following the date of the Isau- aha of the approval of tit Certificate of Construction Compliance of tit 1 system or any repairs t o; 2) that the drilled wall described above ww be.laeated es dawn on the appoved plan and that said wall will be Metal or nce with- the.st S. rules and relu—of the Putnam CotnrtY O st ills M alth. Clete 7 Signed V P.E. X _ R.A. P.O. Box 3 7 4 rewster NY 10 5 License No 0 5 10 11 APPROVED FOR CONSTRUCTItNtt This approval expires two Viser—SWyom the date inued unless construction of the building has been undertaken and Is Mtao46Is for Cause or may be amended or modified when c-onpliered qdcassary by mmissioner of Health. Any change or alteration of construction reeukos a now wmiL Approved for diapoMl of domed sea Y a date water supply only. �Q Rev. to /era °iti t t By Title ' PDiZ "COUM IDZPA227AZM OF HEAL= �?/ DtwYaseii lieeftSeevdoee.CammLN.Y.145U U 00 N tEUM FOR UWACE DOPAL SYSI'®Il lossislied,dAisa Court (off Maple Avenue do Pnrvlda leeMK 0 mI CUTUVATZ OF ADUAMM P.— o P- 6- 91Renewal Patterson -+ /v / Tows er SdWj, a gR Nerve Grundman & Re i s ers,,_ w dl 3 wG~.'T.. r._ 1 r 4 ,� 2.23 �� � James Grundman B ---1 ❑ Nesse Dade of Provloms Approval ugessA 6. 469 Watermelon Hill Road Tow. Mahopac ZIP 10541 Date Subdivision Approved PCHD - 6/9/89 Fee Enclosed ❑ Amniint NA - Paid PPB - 9/27/89 SubdivisdLon Adyb s Type Residential Let Ara, FE Section Oaabr Dom, Yokme Neaber of Beilroesa 3 Doman F)osr G P D 600 PCHD NodBawfloa Is Bevd<md whim FM 4 completed separada seweergle Sy dam a owners d 10 00 Gabon Sepd Tams ana 300 LF by 24" wide trench Te be eamalamded by Not selected Adlizees wafer Seap*: Pdit Supply Ftos Ad&vu an X p.s,.,% S.* D,MW by No t s e l e c to d ddlom OdlaarRegdtememu 205 T.F of mirtain rlrain t-n he inst -al ],Pri 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sswaee dispoal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules and re/u nos o nam County Department 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, hairs or assigns by the buckler, that said builder will plate in pod operating condition any part of said savage disposal system during the period of two (2) yeas Immediately following thedate of the Issu- emco of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that told wall will be Installed 'n rdanos with t rules and feu on$ of the Putnam county Department of Hash. Onto Signed P.E.— R.A. Address P.O. Box 374 rewster NY 509 License NO 051011 APPROVEO FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be anm%OW or modified when considered necessary gy the Commissioner of Health. Any charge or alteration of construction squires • w yt�. Approved fforr lWppooml.of dolt le sanitary sewage, and /or ivate water supply only. � Rn lAA at..���� �'i�� 7 / gy���_ �" / /Title �nV !VlRMC011[ 11MAtMM0FRIALTR plltle�dewlielnwlelBlell�Nglta�a .Ctsel.If.Y.low _ OFCO DmsC)/ CONEWCOM r room FOS MMAM DBRO/AL fYQBft W � i •.. "' �/ Patterson isa Court off Maple Avenue Grundman & Raise 3 Ta� 1 4 2 23 ..,,, ,a, *re.� ❑ bwltia. ❑ O.moldAS bont.— James Grundman Daft d Previte Appaievd MriOAAiwr 469 Watermelon Hill Road Tom Mahopac np 10541 Date Subdivision Approved PCHD — 6/9/89 Fee Enclosed ❑ Amn„nt NA- Paid PPB - 9/27/89 Subdi I vision PR �� a Residential la Ate. FE Sedhe 01114 DW& . VOWme tAnw .w d 3 Deaiiip raw G P D 600 PM PI WIN n- 18 284shwl wbem PBl Y aspbtlad 5"MANSetwn053 fdlsreenmd 1000 gdSgp&T" -A 300 LF by 24" wide trench T,b;ewsk dedby Not selected wow frts AfWes on X mr'fafNI M 110 00" byNni- SA l on+-�ess Olbar>lealiesull 205 LF of 3r ai n Arai n f-n ha i nstallerl 1 represent'ahat 1 am wholly and completely responsible for the design and location of the proposed sydem(s); 1) that the separate aaw di $ai stem above dmcribod will be Constructed as shown on the approved amendment thereto and an accordance with the standards, rules a rasa ns m County Department of MORI% and that on completion.thersof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Halthwill be submitted to the Department, and a written guarantse will be furnished the owner. his sucessaws. heirs or asayns by the builder, that said bulkier will Peep ih pod .operaatkig GNMRion. any part of said awala disposal system during the period of two (2) years lately following the date of the Isau- aha of the approval of tit Certificate of Construction Compliance of tit 1 system or any repairs t o; 2) that the drilled wall described above ww be.laeated es dawn on the appoved plan and that said wall will be Metal or nce with- the.st S. rules and relu—of the Putnam CotnrtY O st ills M alth. Clete 7 Signed V P.E. X _ R.A. P.O. Box 3 7 4 rewster NY 10 5 License No 0 5 10 11 APPROVED FOR CONSTRUCTItNtt This approval expires two Viser—SWyom the date inued unless construction of the building has been undertaken and Is Mtao46Is for Cause or may be amended or modified when c-onpliered qdcassary by mmissioner of Health. Any change or alteration of construction reeukos a now wmiL Approved for diapoMl of domed sea Y a date water supply only. �Q Rev. to /era °iti t t By Title ' PDiZ "COUM IDZPA227AZM OF HEAL= �?/ DtwYaseii lieeftSeevdoee.CammLN.Y.145U U 00 N tEUM FOR UWACE DOPAL SYSI'®Il lossislied,dAisa Court (off Maple Avenue do Pnrvlda leeMK 0 mI CUTUVATZ OF ADUAMM P.— o P- 6- 91Renewal Patterson -+ /v / Tows er SdWj, a gR Nerve Grundman & Re i s ers,,_ w dl 3 wG~.'T.. r._ 1 r 4 ,� 2.23 �� � James Grundman B ---1 ❑ Nesse Dade of Provloms Approval ugessA 6. 469 Watermelon Hill Road Tow. Mahopac ZIP 10541 Date Subdivision Approved PCHD - 6/9/89 Fee Enclosed ❑ Amniint NA - Paid PPB - 9/27/89 SubdivisdLon Adyb s Type Residential Let Ara, FE Section Oaabr Dom, Yokme Neaber of Beilroesa 3 Doman F)osr G P D 600 PCHD NodBawfloa Is Bevd<md whim FM 4 completed separada seweergle Sy dam a owners d 10 00 Gabon Sepd Tams ana 300 LF by 24" wide trench Te be eamalamded by Not selected Adlizees wafer Seap*: Pdit Supply Ftos Ad&vu an X p.s,.,% S.* D,MW by No t s e l e c to d ddlom OdlaarRegdtememu 205 T.F of mirtain rlrain t-n he inst -al ],Pri 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sswaee dispoal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules and re/u nos o nam County Department 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, hairs or assigns by the buckler, that said builder will plate in pod operating condition any part of said savage disposal system during the period of two (2) yeas Immediately following thedate of the Issu- emco of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that told wall will be Installed 'n rdanos with t rules and feu on$ of the Putnam county Department of Hash. Onto Signed P.E.— R.A. Address P.O. Box 374 rewster NY 509 License NO 051011 APPROVEO FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be anm%OW or modified when considered necessary gy the Commissioner of Health. Any charge or alteration of construction squires • w yt�. Approved fforr lWppooml.of dolt le sanitary sewage, and /or ivate water supply only. � Rn lAA at..���� �'i�� 7 / gy���_ �" / /Title �nV PARTMENT OF HEALTH Divis n o' Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL c, PCHD PERMIT WELL LOCATION Street Address Town /*4!""--- / 4y Tax I Grid Number Lisa Court Patterson 1 -4 -2.23 4ELL OWNER Name . Mailing Address Mahopac, NY ®Private Jim Grundman 469 Watermelon Hill Road 10541 0Public OF WELL ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 ABANDONED 5SE primary O BUSINESS O FARM Q TEST /OBSERVATION ❑ OTHER (specify, = secondary ❑ INDUSTRIAL U INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 600 gal 2EASON FOR ®NEW SUPPLY DPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION DRILLING ❑REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL )ETAILED ---Lot to be residentially developed REASON FOR GRILLING 'ELL TYPE X)DRILLED DRIVEN [JDUG GRAVEL OTHER 3 WELL SITE SUBJECT TO FLOODING? YES X NO 7 WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Jim Grundman/ _ Michael Re�i st -r L1ai vi Gi on Lot No ._3 :TER WELL CONTRACTOR: Name Hyatt & Son Address: pat t Px-s-an- PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X 1\'0 SE OF PUBLIC WATER SUPPLY: TO ?N /VIL /CITY STANCE TO PROPERTY FROM NEAREST WATER MAIN: '.ATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION ©ON S �PARATE SHEET �� ,date) & g 9u re) Philip A. Leger -- JRFA 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 s.hall: 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 provi ed,by the Putnam County Health Department. 1 Date of Issue: 19 Date of Expiration: 1 19 Peitit Issuing Official Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2187 Pink Copy: Owner Orange copy: Well Drillc-r PC -1 PUTNAM COUNTY DEPARTMENT O V H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: James Grundman 469 Watermelon Hill Road Mahopac, NY 10541 2. Name of Project: Grundman - Lot 3 3. Location © /V /C: Patterson 4. Project Engineer: J. Robert Folchetti & 5. Address: P. O. Box 374 License Number: Associates 051011 Brewster, NY 10509 Phone: 279 -3346 6. Type of Project: NA Distance to water X Private /Residential Food Service Commercial 19. Apartments Institutional Mobile Home Park sewage collection or disposal system ?..... Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? NA Distance to sewage Type Status (Check One) Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. No 9. Has DEIS been completed and found acceptable by Lead Agency? NA 10. Name of Lead Agency - NA 11. Is this project in an area under the control of local planning, toning, or other officials, ordinances? .... ... ............................... Yes 12. If so, have plans been submitted to such authorities? Yes FINAL SUBDIVISION 13. Has - pelimina- yAapproval been granted by such authorities? Yes Date Granted: 9/27/89 14. Type of Sewage Disposal System Discharge...... Surface Water X Ground Waters 15. If surface water discharge, what is the stream class designation ?........ NA 16. Waters index number (surface) ........... ............................... NA 17. Is project located near a public water supply system? .................. No 18. If yes, name of water supply NA Distance to water supply NA 19. Is project site near a public sewage collection or disposal system ?..... No 20. Name of sewage system NA Distance to sewage system NA 21. Date observed: 23. Name of Health Inspector: 6 00 24. Project design flow (gallons per day) ...... ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 2. No 26. Has SPDES Application been submitted to local DEC Office? NA 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... No 28. Wetland ID Number ........................ ............................... NA 29. Is Wetland Permit required? .............. ............................... No Has application been made to Town or Local DEC Office? NA . 30. Does project require a DEC Stream Disturbance Permit? ................... No known to be 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other, crops, solid or hazardous waste disposal, Not Known landfilling, sludge application or industrial activity? ........ YES or NO To Be known to be 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or Not Known any other potential known source of contamination? ..............YES or NO To B e DESCRIBE• Solid waste previously on subdivision site has been removed. Soil samples from site indicate no contamination. 33. Is there a local master plan or file with the Town or Village? ........... Yes 34. Are community water, sewer facilities planned to be developed within 15 years? No 35. Are any sewage disposal areas in excess of 15% slope? ........................ No 36. Tax Map ID Number ........................................................ 1-4-2.23 37. Approved Plans are to be returned to: ................ Applicant X 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 belief. False statements made herein are punishable as a Class A Nisdemeano pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLED: MAILING ADDRESS: 4L� /Ok- caner 469 Watermelon Hill Road, Mahopac. NY 10541 /• aXJNTY DEPARTMENT OF DESIGN DATA SHEET- SUBSUFACE S&gAGE DIS t:ess SYSTEM FILE NO. �ps O James Grundman 469 Watermelon."Hill Road, Mahopac Located at (Street) Lisa Court (off (Maple Road) Sec. l.`,' Block 4 Lot 2.23 (indicate nearest ;cross street) Municipality (T) Patterson Date of Pre - Soaking 5/ 2 0/ 8 8 .. Croton APPLICATIONS„ k -- Date of Percolation Test.- 5%20/8'8 HOLE NUMBER' CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches PH5 1 3:00 -3' :05 5 20 24 4 1.25 2 3 :06 -3 :11 5 . 19 23 4 1.25 3 3:15 -3 :20 5 20 24 4 1.25 4 5 PH6 1 3:16 -3 :40 24 19 23 4 6 2 3:41 -4 :05 24 19 23 4 6 3 4:05 -4 :35 30 19 24 5 6 4 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 sutmitt�d for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 PIT DATA, HOLE, N0:_ 5 0- 10"•Med Grey Loam 10 " -30" Lt Brown GR, SA 30" -108" Pale Yellow Brown End 108" No Rock No H.,, 0 HOLE NO. 6 0- 12 ":Med Dk. Grey Loam 12 " -32" Tan SI, SA 32" -104" Olive Grey SA, CL End 104" No Rock H.0 at 514" INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED 5'4" HOLE NO. INDICA'T'E LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTE M 5'4" DEEP HOLE OBSERVATIONS MADE BY: TFV DATE: 5/16/88 DESIGN Soil Rate Used 6 Min /1" Drop: S.-D. Usable Area Provided 5 , 000 + SF No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type PCC Absorption Area Provided By 300 L.F. x 24 width trench Other 205 LF of Curtain Drain Name J. R. Folchetti & Associates Signature .Address P. 0. Box 374 SEAL r Brewster, NY 10509" THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil. Rate Approved _ sq.ft /gal. Checked by _ 6 Fn.'"_ O INN iir �:.14�'•r Date 460 N. /f 24,7 14/ I fryer« ,9tie,voE a6u-j r� �.� \ �4s2