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HomeMy WebLinkAbout0102DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 01- 589 -8100 3.19 -1 -84 BOX 2 00102 � i J I �,. Ire ki J t6 � . L ; I , ' �6 h �. T, , , 00102 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Addres Town/Village: 2LhLCJ-j Tax Grid # Map �,l Block j Lots)' Well Owner: Name•, I j dd ss: / Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond /heat puml6 Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion 7T Compressed air percussion Other (specify) Well Type Screened Open end '.casing Open hole in bedrock Other Casing Details Total length 3 ft. Length below grade W 2q ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic Other Joints: Welded A Threaded Other Seal: Cement grout _ 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 Compressed Air Hours Yield k rgpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed/ etaile information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface J Id Kle" ,�A /DD .� f' Ali I If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information' /- Pump Type 5� Capacity % �e Depth l20 Model 16 i.-_6 4l Z Voltage -�L 3v HP t = =' Tank Typd X-3oZ Volume 8� Date Well Co leted Putnam County Certification No. l� Date of Report a Well Driller (signature) 7; NOTE: Exact location of well with „distan es to at least two permaneht landmarks to be provide . /djYa sdparate sheet/plan. "5�r�eLN Well Driller's Name � W �� Address: R, Signature: Date: / White copy: HD �i/le; Yellow copy - Building Inspector; Pink copy - Owner; Orange co PY - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # _3 ---- -- Located at -i Town or V age Subdivision name (�rti� �� %� e Subd. Lot # 3 Tax Map' 13,12 Block _L_ Lot Date Subdivision Approved / Z Owner /Applicant Name A Mailing Address P-16 , e a /1 -3 Amount of Fee Enclosed t Renewal Revision Date of Previous Approval IZ4 0 /. Y zip i f �. Building Type R1_- ; d Lot Areal,13,116 No. of Bedrooms '� Design Flow GPD (fo6 d Fill Section Only Depth Volume PrHn NOTIFICATION IS RROUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and Other Requirements: ' -5) 2,�' 9,o .13- To be constructed by T A jl. Address Water Supply: Public Supply From Address or: Private Supply Drilled by -% 6 l.) Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a,.written guarantee will be furnished thin owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. !/ R. A. Date 3 1r! Id -- Address - '?j 9 ` �e, i� —License .# 5 12-4 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 wheqx.,onsidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi 7777 discharge of domestic sanitary sewage only. rR-- r By: l Ti tle: Date: S LJ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 March 14, 2005 Department of Health 1 Geneva Road Brewster, NY 10509 ATT: Robert Morris, P.E. RE: Trench Permit — Lot # 39 Van Cleef Subdivision 985 NYS Route 311 Patterson, NY T.M. # 13.19 -1 -84 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com The fill pad for Lot # 39 has been inspected and accepted by the PCHD. Accordingly, we are enclosing the "Construction Permit ", dated 03/11/05 for installation of the trench system. Kindly process at your earliest convenience. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:gav 02- 095.39 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS' �p PCHD CONSTRUCTION PERMIT # 1 00 0 3 Located at Jj , Owner /Applicant Name lilt 4 k g Formerly , Mailing Address )0, C= 60 i133 Town or, Ji Qge Tax Map 13; l `l Block _� Lot Subdivision Name C �T Subd. Lot # ;3 Ca,31 LA%.t,,I Date Construction Permit Issued by PCHD to-11 -01 Separate Sewerage System built by At �� � 4 id Address Consisting of 1006 Gallon Septic Tank and 3'1 'Au Other Requirements: r Zip v5`t Z Water Supply: Public Supply From Address I CG , or: Private Supply Drilled by �J 14 r �] fey , Cs. h 42 a..l � Address i O �-f PC- Building Type - ke. � L ; eJ tc4 1 Has erosion control been completed? Number of Bedrooms 3 Has garbage grinder been installed? c:.,4 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 pf the Putnam County DepaV went of Health. Date: -- j -U-r Certified by Address P.E. Z�--' R.A. License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private ater supply shall become null and void when a public water supply becomes available. Such approvals e s bjec modification or change when, in the judgment of the Public Health Director, such revocatio ific or change is necessary. By: Title: fx— Date: o f White copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Addres • Town/Village: I Tax Grid # Map i 11q Block 1 Lot(s) Well Owner: Name:, 1 Add ss: eI V �l lol),51oq Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pum Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion K Compressed air percussion Other (specify) Well Type 'Screened Open end casing C Open hole in bedrock _ Other Casing,Details Total length Lj I T35 ft. Length below grade ` 0 q ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: I Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes `. No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet 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 1 2 f� • 0 /&r lb 4 f' �a If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information IbG' Pump Type Capacity Depth 126 ! Model iC Lrj 1(1$12- Voltage 3v HP 1 Tank Typo X -SO.Z Volume V1 Date Well Co pleted V Putnam County Certification No. 143 Date of Report Well Driller (signature) NOTE.: Exact location of well with distances to at least two permane t landmarks to be provide .o a s parate shee plan. N-en2L( P� -� � 0� n 09- Well Driller's Name o Signature: Date: % White copy: HD ile; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 { }� BRUCE R_ FOL LORMA MOLMM-RN., M.S.N. EY �. Public Health Dlrrcroro - - �• i,. •ItuocW( Publk,. Heal lh .Dkrvar... _- Dlrrclor • Qf Pat'hiv &rvic(l - -- DEPARTMENT OF ' 1-MjkL H 1 Gcnova -Road.-.- _ • Browstor, Ncw York '10509 Eartroa 141 Halts (914)271.6170 Fix (914) 27t -1921 . xartl at.& rrtca( 9 .14 >27t•6532...WIC(91tj27F�667t .F1sc(9r4 >27t -6ou .. . —..... —.� __.: .. .. "— Lrriy'lelcrrinToa- (914)11r -6014 Pruchool (914)27:•6022 Fix(914)27t' -6641 - F/911 A.DDR ,SS'V ,RIFICATION FORM OWNERS NAME: t �� z; r r 4p" fia TAX*"- DUMBER, - -- 3 , I `i E911 ADDRESS;., �nf�J 51 S _. TOWN: �UTHOR7ZED TO _- BSmIAI, :. (Signature) ' .. DATE: • � - - _... ... � ,3 �� _.. Thy Putnam County Department of Health will not issue a -Certificate :of Construction Compliance-unless the above form is.colnpleted' i.e., a legal E911 address is assigned b _ an authorized town official. This farlm is to be submitted• -- _y . . with the application for a Certificate of Construction Compliance. (E91 l VERFF K - ♦ I. . r - J 'ill. •• .. w•M. ._ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 1 I"aY,-1 ar,�e Ito Owner or Purchaser of Building Building Constructed by , Location - Street Building Type,' , 13i /9 ! 91 Tax Map Block Lot TownNillage Subdivision Name 3� Subdivision Lot # I represent that I am wholly- and completely responsible for the location, workmanship, material, constractioil and''draina'ge of the sewage ireatment.system serving the' above- 6scribed'property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition. any parr–of said Iysterh coris1ructed 667' me which fails'to operate fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the systerrl L�+,d/ nth Day 3 Year X005— Signature: .... ­Gen (Owner) - Signature Corporation Name (if corporation) Address: AAe, �,o 41 State j Zip / 5 Title:- Corporation Name (if corporation) Address: State Zip Form GS -97 May 3, 2005 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fax: (845) 279 -4567 Email: hnengineer@aol.com RE: Individual SSTS Compliance — Cariello 985 Route 311 Patterson, NY T.M. # 13.19 -1 -84 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -37 "As -Built SSTS ", dated 05/03/05. 2. "Certificate of Construction Compliance for Sewage Treatment System ". 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 05/03/05. 4. Laboratory Report, dated 04/18/05. 5. "Well Completion. Report", dated 02/18/05. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 05/03/05. If there are any questions concerning the enclosed, please call. Very truly yours, i_ Harry W. Nichols Jr., P.E. HWN:gav 04- 061.00 , . YML ENVIRONMENTAL SERVICES 321 Kear Street ' Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 9.500685 CLIENT ON 58340 CARIELLQ, MICHAEL P.O. BOX 1133 CARMEL, NY -10512 NON STAT PRDC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 04/08/05 1l:&0 DATE/TIME REC'D: 04/08/05 11:35 REPORT DATE: 04/18/05 PHONE: (845)-494-4967 SAMPLING SITE: 985 RT 311, PATTERSON SAMPLE TYPE..: PQTABLE : WATER SPICKET (HOSE) PRESERVATIVES: NONE COL'D BY: MICHAEL CARIELLO TEMPERATURE..: NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/08/05 MF T. COLIFDRM ABSENT /100 ML ABSENT' 1008 04/08/05 LEAD (IMQ <1 ppb 0-15 ppb 9003 04/08/05 NITRATE NITROG 0.58 MG/L 0 - 10 9052 04/08/05 NITRITE NITROG <0.01 MG /L. N/A 9162 04/08/05 IRON (Fe) 0.211 MG/L 0-0.3 mg/l 9002 04/08/05 MANGANESE (Mn) 0.342 MG/L 0-0.3 mg/1 900-1. 04/08/05 SODIUM (Na) 13.3 MG/L N/A 9002 04/08/05 pH 7.6 UNITS 6.5-8.5 9043 04/08/05 HARDNESS,TOTAL 190 MG/L N/A 04/08/05 ALKALINITY (AS 134 MG/L N/A 900J. 04/08/05 TURBIDITY (TUR 2.0 NTU O-5 NTU COMMENTS: FAX TO 845-255-9029 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be t ti l !zo en a . ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. - YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (9l4> 245-2800 Albert H. Padovani, Director LAB #:'9.500685 CLIENT #: 5834� NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CARIELLO, MICHAEL P.O. BOX 1i33 CARMEL. NY 10512 DATE/TIME TAKEN: 04/08/05 1ii0O DATE/TIME REC'D: 04/08/O5 11:35 REPORT DATE: 04/18/05 PHONE: (845)-494-4967 SAMPLING SITE: 985 RT 311, PATTERSON SAMPLE TYPE..s POTABLE : WATER SPICKET (HOSE) PRESERVATIVES: NONE COL'D BY: MICHAEL CARIELLO TEMPERATURE..I: NOTES...: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5, Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L, THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L M8/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/1 SUBMITTED BY: Albert Directo ELAP# 10323 NORTHEAST LABORATORIES, INC. 129 MILL STREET - BERLIN, CT 06037 -9990 [Danbury Office and Sample Drop Off Site: 100 Mill Plain Road, Suite 342, Danbury, CT 06811] TELEPHONE: Toll Free (in CT) 800 - 826 -0105 (Outside CT) 800- 654 -1230 Berlin /Hartford Area: (860) 828 -9787 Danbury Area: (203) 791 -3874 FAX: (860) 829 -1050 E -Mail: NELABSCT @AOL.COM www.NortheastLaboratories.com REPORT TO: MICHAEL CARIELLO P.O. BOX #1133 CARMEL, NY 10512 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED CHEMISTRY: • Manganese DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: DATE TESTED: LAB ID# REPORT EM REPORT DATE: 985 ROUTE 311, PATTERSON, NY KITCHEN TAP WELL DRINKING WATER NONE .,p A c C 0.* N� PAGE 1 OF 1 05/24/2005 2:15PM MICHAEL CARIELLO 05/24/2005 LAB# 11471 0.5/31/2005 0504887 -01 D0504887 05/31/2005 MAXIMUM CONTAMINANT LEVEL (MCL) OR RESULTS UNITS METHOD # STANDARD <0.01 mg/L EPA 243.1 '0.50 mg/L * ** DATE TIME TESTED TESTED 05/31/2005 --- ml= milliliter mg/L--milligrams per Liter ND =none detected MCI,—Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level <Q= Analyte detected below quantitation limits data deemed estimated. 3° Water containing more than 20 mg/L of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/L of sodium should not be used for drinking by people on moderately restricted sodium diets. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (were) met. :. 4 � P4 p Approved By: Laboratory Director CT Cert. #PH -0606 & #PH0404 NY Cert. #11471 EPA Cert. #CT -024 USDA Cert. #0976 FDA Reg. #3001743770 DEA Reg. #624 Street Location Town TM#— PUTNAM COUNTY DEPARTMENT OF HEAL DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION 1. Sewaze Svstem Area a. STS area located as per approved plans .......... : ................ b. Fill section - date of placement 3:1 barrier Lgth, Width Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/mmaQds ..................................... IL Sewaize System a. Septic tanks' - 000 250 ......... other ...... C. 1��* b. 'Septic'unk i�--; e ----- .................................. c. 10' minimum from foundation,. ............................. d. ::-Distribution A I— All —odt-17efs-at same elevation-water tested 2. Protected below frost ...................................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set ......................................... 6. Trenches 1. Length required 37i;g, Length installed 2. Distance to watercourse measured -74- /�OFt .......... 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1116 - 1/32"/foot ............. 5. .10 ft., from property line - 20 ft,.- foundations.......... 6.. Depth of trench <30 inches from surfice ................. 7. Room allowed for expansion, 100% .................... :*- 8. Size of gravel 3/4 - 11/2" diameter clean ................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed 1. Size of pump chamber ................................................ 2.. Overflow tank ............................. ............................... 3. Alarm, visual/audio .... ­­ ­*­" : * ' * ' ' * ' * ' ' * * * ' ­ ........ * ........ 4. Pump easily accessible, manhole to grade ................. 5. First box baffied ......................................................... 6. Cycle witnessed by H.D.estimated flow/cycle ........... 111.1. House/Buildfti2 a. Hp-ii's-e.locate,i..per-apprpyed plans.....- Number.of bedrooms 'YA IV. Well Ni S, (9 -De-4 V A Well located as per approved plans .................................. b. Distance from STS area measured . . ft........... c. Casing. 18" above grade ................................................ d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted .................................................. b. All pipes partially backfdled .......................................... c, All pipes flush with inside of box .................................. d. Backfih material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ..................................... i. Erosion control provided ................................................ Rev. 12102 Date: Inspected by: Owner Permit # Subdivision Lot 4 AOL 3r COMMENTS .K10 SITE INSPECTION FOR FILL PAD Date: Inspected by: Fill pad located per the approved plan Fill Pad Length 3 / /9.3 Required Length Fill Pad Width % Required Width & % Fill Pad Depth 2_ Required Depth 5, 2- Run -of -Bank Fill Quality � Slope from Top to Toe a Impervious Layer Installed , Erosion Control Installed Sieve Test Results (if applicable ) � Additional Comments: �r, Cris` ct r'k ��,C,. /" OC4 1e 5 �� �xf ����f!. lOC2 i Reserved for Field Sketch if Applicable i 05'.-15 PN HARRY W NICHOLS 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES BEQJ JES1 FOB. EjN AL-INSPE=ON For: Fill Date: Trenches PCHD Construction Permit # P Located: A) Y'c;' (T) (V) Owner/Applicant Name: I CL—ew. C'wc I TM Block Lot Formerly: 1? T- t, SubdiviSioa :Nabie:, Subdivision Lot C Ie_ L 15'systein fill completed? 1 Date, A Is s system complete? A)e Date: Is system constructed as'per pla6? -Al Is well dril]4d?. d Date: Is well.located as per platis? Are erosiou'obntrol measures,in plice? I certify that the.system(s), as listed, at the-above premises. has beets constructed and I have inspected and .verified their completion in accoirdain,'cie with the issued PCM Construction Permit and approved plans and the Standards, Mules and Reigulations of the .Putnam County Department of Health, Date. Certifi6d by: - PF, RA 4pWD Profession af/ P.01 6) -1-0 4/ Address:. Y4 Lic. 4 1 -7— Cnmmmt-q- Form FIR-99 .a SHERLITA AMLER, MD, MS, FAAP. Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 27, 2005 Mr. Harry Nichols Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Pad — Cariello NYS Route 311, (T) Patterson Lot #39, T.M. #13.19 -1 -84 ROBERT J. BONDI County Executive An inspection of the fill pad at the above referenced project has been completed. Comments are offered as followed. 1. Upon inspection it was noted that a drainage ditch within 100 feet of the fill pad had running water in it. Therefore this lot does not meet current codes at this time. 2. Please note that field measurements by this Department in no way suggest the exact size, depth and location of the fill pad. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed , Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health April 20, 2005 Harry Nichols P.E. . Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — Cariello NYS Route 311, (T) Patterson Lot 39, T.M. #13.19-1-84 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected: • Upon inspection by this Department, it was noted that the residence has a count of 4 bedrooms. The permit signed by this Department is for 3 bedrooms. If you have any further questions, please. contact me at (845) 278 -6130, ext. 2261. GDR:cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SENDING CONFIRMATION DATE : APR-25-2005 MON 13:27 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE PAGES START TIME ELAPSED TIME MODE RESULTS 92794567 APR-25 13:26 00'40" G3 OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.... SHERIATA AMUR, MD. MS, FAAP ROBERT L BONDt n,aw 1,01(VITA AII)LLVART, RN, MSN DEPARTMENI' OF HEALTI-1 I Geneve Rend. ..) r !0500 April 20, 2005 Hairy Nichols P.P. , Patterson Park Suite 106 20?O Routo 22 I NY 10509 CiDR:cw = N'v".X'—(84S)27h6S58 WTC(114r'12'4a611, F.,A(845)779.6085 Early 1.t0mmdd,1Prmd­1 (1145) 219 -t; I I ; 1. f9l'1.76;6618 T)lr,W MT. Nidtofii: The above referenced dcltOratc 9cwtfL'.,'• tre,11,11-W .•m :,il :-.c kivi-Xilled. The following conuncom must be corrected: A Upun inspection by this Departmeni, it -i- mtcd that the residence hus a r.nvnt of 4 bedrooms. Thi permit.qipri,:d by ibis Depa- ritent if, tor 3 licch-tionts. if you have any further clucstictris, plvuw contact n, • ir 6130, act. 2261. Ger.e 1). izo,t Sr. Unvirr,!i .-j: t I fcMOI t'it,,incering Aidf- CiDR:cw = N'v".X'—(84S)27h6S58 WTC(114r'12'4a611, F.,A(845)779.6085 Early 1.t0mmdd,1Prmd­1 (1145) 219 -t; I I ; 1. f9l'1.76;6618 APR-12-2005 0§ :59 AM HARRY W NICHOLS 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DM,- SION.01? IMMONMEMAL HEALTH SERVICES MQUES1 FOR FIN& INSE, ECLON For:. Fill Date: 6* -1. - 0A Trenches PCHD Constriction Permit N I-QA Located: 9.1rS 9 q;5 14JT& -su (T) R FA M&1fi'0AJ Owner /Applicant Name: '%414%Aj L e-A&%t-LLa TM 13-I9 'Block I Lot Formerly: Subdivision Name: gak%- ciao Subdivision Lot ;S,systew--filt 'completed?' Date., I'S System complete?, JAL Date: 64-11-05 Is system constructed as per plans? is 'Aie'll drilled? Ytz Date: -a4 - it. 10s Is well located as pia,plans? Are erosion control measures in plaoe? 1 certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their (c)'mioletion. in Accordance with the issued PCHD Construction Permit and P. 01 APR-12-2005 TUE 10:17 TEL:845-27e-7921 1--*AME:PUTNAM COUNTY DFPARTMFNT nF P- 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 3, 2005 Harry Nichols P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — Cariello NYS Route 311, (T) Patterson Lot 39, T.M. #13.19 -1 -84 A re- inspection at the above referenced lot has been completed. Due to the construction change to the room labeled "den ", a revised floor plan needs to be submitted to this Department for approval. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845)278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # "� 3 Located at ✓V IS X ire. 3 / ) Subdivision name f ��.� c l e.� Subd. Lot # 3 Date Subdivision Approved a-- g Owner /Applicant Name /d.{ �_�, �; r C1 r t - 611 Mailing Address 0, 6 . d o x / Amount of Fee Enclosed Town or Tax Map )3,19 Block j Lot Renewal Revision V/ Date of Previous Approval Zip /65,12— Building Type R r-c— e— Lot Area -1,946- No. of Bedrooms Design Flow GPD y(; Fill Section Only X, Depth 3 ; 2-S' Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of f U 00 gallon septic tank and 3`71� 14 ', 6 .5 i v� -.chess Other Requirements: z, 2-. re, 0, 13- To be constructed by ' y A 1Q Address Water Supply: Public Supply From Address or: i! Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewaU treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 10 —1-4-04 License # '�� 1 2 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 w c nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. ppro d discharge of domestic sanitary sewage only. By: ! Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ please print or type PCHD Permit # P, R Well Location: Street Address: Town/Village Tax Grid # 3 % AJ e C L, Map 13,1c1 Block / Lot(s)g;'f Well Owner: Name: Address: 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 ; gpm # People Served 3 - �— Est. of Daily Usage Q Q gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling r/ New Supply (new dwelling) Deepen Existing Well Detailed Reason Vey for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes ;; No Name of subdivision Lot No. Water Well Contractor: T9 D Address: Is Public Water Supply available to site? ............)) .................. .I............................. Yes No L--' Name of Public Water Supply: W / 4. Town/Village Distance to property from nearest water main: _ � M7 Proposed well location & sources of contamination on be provided on separate shee pl . Date: 10-0-0 � 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. An revision or alteration of the approved plan requires a new permit. Well to be constructed by a water 11 iller certified by Putnam County. / Date of Issue �� �, Permit Issui - Qf�fic�' %tom Date of Expiration a p Title: Permit is Non -Trans er •ab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEAL DIVISION OF ENVIRONMENTAL HEALTH SEIR CONSTRUCTION PERMIT FOR SEWAGE TREATMENT S PERMIT # P " I - t) Located at 01 55 Hy A- Rev l j� r'51 a 1 Town or Village PATTER -60N Subdivision name \[AH COI F' Subd. Lot # I Tax Map 1� y Block ` Lot Date Subdivision Approved � 24 91+1 qq Renewal Revision W C�N Owner /Applicant Name MAAAa— CA(24f�LIIO Date of Previous Approval 061 im Mailing Address P° 4 , W( i►lb-� CAR-(fTL. N'� zip JDslt Amount of Fee Enclosed Building Type P-C-10I DC K/6 Lot Area 4. W, No. of Bedrooms fb Design Flow GPD (P Qb Fill Section Only ( Depth 'Q) J4 Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ODD gallon septic tank and � ')T 14' A Other Requirements: w r'11.1— To be constructed by Address Water Supply: Public Supply From Address or: �4- Private Supply Drilled by T-Qi% Address 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 constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. j Signed: P.E. R.A. Date Address r_od�-L) v p- v�- cJ N' T/ 10TtA License # 5C l APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment s stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe on ) idered necessary by the Public Health Director. Any rev' 'on or alteration of the approv d pl regnires anew perm' . joved1discharg&of domestic sanitary sewa ly. � )(�.� �Wl x i' By: Title: Date: �' y;01 ' White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional' Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # F —b 'Of� Well Location: Street Address: Town/Village Tax Grid # 186 W6 iLo'.ti E / j11 PST E12-60 J Map MA u I Block Lot(s) -1 Well Owner: Name: hotel, Address: F° D,Bo�. 111) 1� ` 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 5'+' gpm # People Served _G Est. of Daily Usage '64D gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ?G, Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision VA Fl c,,L -a F' Lot No. /hN Water Well Contractor: T-K) Address: 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 be provided on separat sheet/plan. Date. P-711 ��! 4 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. An. evision or alteration of the approved plan requires a ew ermit. Well to be constructed. by a water w l � l dr ller certified by Putnam County. Date of Issue Permit Issuin >cial. Date of Expiratio ��j- -Title: l Permit is Non- Transferra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT Ge' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #`'~ ''µl Located at i ``, - Town or Village`' Subdivision name ` p? Subd. Lot # Tax Map `' `4 Block Lots Date Subdivision Approved Renewal . Revision Owner /Applicant Name Date of Previous Approval Mailing Address Amount of Fee Enclosed Zip Building Type Lot Area 4, "i No. of Bedrooms Design Flow GPD` Fill Section Only , Depth 4), , ) ` Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements ;, 1"', r L. gallon septic tank and 5 To be constructed by ; s Address Water Sunblv:. Public Supply From or: Private Supply Drilled by it Address Address 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 constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion 1�thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: / �i _ . 1 ... P.E. A R.A. Date () 1, - 4 %, -J"!� I• ^ Address t S j i.. ,, ,+• p , ,� �i License # e t 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. Aiiy revision or alteration of the approved plan requires a new permit;: Approved £gr',?discharge of domestic sanitary sewage -only. By: Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I • 1 _ OEOAOOW 3 BEDROO1•( 2 ALL I MEN" . �Am UTNAM COUNTY pUSE PLANS APPROVED ooM COUNT e g . BEDROOMS E - 'prbo FOR AYYtt�ar PLANS t1S tE aiJ' li. First F!oo ~� \ DINING 80614 KITCHEN !�. -G' x 13' -0' L'- Cx13' -G' r 27,8., UASTER BEOROOM 14 - 1' x r3'- G' ~' LIVIHC ROOM. O'x 13,- O' u r 1 FZ X51 .:f��N_c,:���- ......_•....... _ .. � r • t i ~� \ DINING 80614 KITCHEN !�. -G' x 13' -0' L'- Cx13' -G' r 27,8., UASTER BEOROOM 14 - 1' x r3'- G' ~' LIVIHC ROOM. O'x 13,- O' u r 1 FZ X51 .:f��N_c,:���- ......_•....... _ .. r, ssional has inspected the ROB fill material on date 7ify - Oat'sach- material has been placed.and stabilized th:e requirements -of the'NYS Department of Health, Dept rtrnent of Health and the approvedfiil plan. The been tested and at this time is considered suitable for sewage treatment system. The soil percolation rate in on percolation tests, after stabilization is SIGNED:: Design Professional Putnam County Department of 1ealth' Division of Environmental Health Ser"vi -ces Appr ed s noted for conformance with gbp�,i -b a Rule nd Regulations of the P ' Co Health Departmen i 0 SL:�j_iat -=6 .& Title tt A. �) 1%OR. PGHD APPROVAL. STAMP EXIST. STONE WALL TO BE REMOVED acv, 04 -i► -03 PROPOSED SSTS VAN CLEEF ESTATES SUBDIVISION LOT N'39 ROUTE 311 ...N . .... ....... ... ... _..._. _. _- _.. _ N Ev4_ _Y_0-P`l< REILLY CONSTRUMON 2140 RT 22 BREwsTER.._ NEW..,YORR Harry W. Nichols Jr., RE Suite 106, Patterson Park 2050 Route 22 Brewster, NY 10509 (845) 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEER; PROPOSED SSTS LOT No 39 �._ I„ =30l pf NEW 02-21-03 NICHp,.' z� H W N w 02-095-39 N 4 Fes, :I S S �J -EGEND : -- %,.,_:OPERTY LINE - -- - - EDGE OF PAVEMENT/ROAD EXISTING BUILDING -� -- L °ems EXISTING GRADE 2 PROPOSED GRADE +02.50 PROPOSED SPOT GRADE _RO /,Ep PROPOSED ROOF & FOOTING DRAINS � Pr. PERCOLATION TEST LOCATION f$� TP TEST. PIT LOCATION -E EXISTING WELL PROPOSED WELL - = ; EXISTING SSDS PROPOSED SSDS EXISTING TREE LINE EXISTING STONE WALL r---r 'T - PROPOSED SILT FENCE == Di-- -- PROPOSED STRAW BALE DIKE EXIST. STONE WALL TO BE REMOVED acv, 04 -i► -03 PROPOSED SSTS VAN CLEEF ESTATES SUBDIVISION LOT N'39 ROUTE 311 ...N . .... ....... ... ... _..._. _. _- _.. _ N Ev4_ _Y_0-P`l< REILLY CONSTRUMON 2140 RT 22 BREwsTER.._ NEW..,YORR Harry W. Nichols Jr., RE Suite 106, Patterson Park 2050 Route 22 Brewster, NY 10509 (845) 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEER; PROPOSED SSTS LOT No 39 �._ I„ =30l pf NEW 02-21-03 NICHp,.' z� H W N w 02-095-39 N 4 Fes, :I S S PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT it Located at���� Subdivision name VAN C-,LI�EF Date Subdivision Approved Owner /Applicant Name 11 C. o 1�t ���A� c,�10 � Date of Previous Approval. Mailing Address X10 W/s Zip 101 Oct Amount of Fee Enclosed Buildin g YP T �' e �660 Ht' -O Lot Area 4' No. of Bedrooms Design Flow GPD � 00 _ Subd. Lot # a -1 m i 9 % 3 Town or Village ` Tax Map l'.` 6 Block Lot Renewal Revision Fill Section Only Depth °h %' 6 Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I'D q " ` gallon septic tank and Other Requirements: To be constructed by Address Water Supply: Public. Supply From Address or: Private Supply Drilled by Address 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 constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs 'thereto. Signed: r1�. �t, tti r . ,.�� f P,. R.A. Date fly-' � 1` a� Address �� 3 0 +� `�-° `'�! � )E. t"i ti i o �1 License # 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 cansidered necessary by the Public Health Director Any revision or alteration of the approved plan requires a new permit: pprove d f /or�di/scharge of domestic sanitary . sewage, only. , u C �! Datefa I 4-5 By: � � Title: ., White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit Well Location: Street Address: Town/Village Tax Grid # P ATf"O H Map 1°41. � 1 Block t Lot(s) Well Owner: Name: Address: j�iLt:� t.,fi�c5; �iJC�Z1�.� -► '�.?��1U �' '2'�, �f�= �,�r!�i�31 ---1 %a f � p �`I�1 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 �54' gpm # People Served ';;6 Est. of Daily Usage 'GOO gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling -?t . New Supply (new dwelling) Deepen Existing Well Detailed Reason t for Drilling.. Well Type — Drilled Driven :. Gravel Other Is "well site subject to flooding? ......... Yes No Is well located in a realty subdivision? ..... ........................................ ........................ Yes. X No Name of. subdivision • V AW C - G Lot No. ?>9 Water-Well Contractor: ' `$�l� Address: - Is Public Water Supply available to site? ........ ....::.........:............... .... ..........:. :.:,... Yes No _. Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 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 maybe' amended or modified when considered necessary by the Public Health Director. /Aaiy revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well .driller certified by Putnam County. r Date of Issue) f - _Permit IssuiriO cial ' /7�t✓ Date of Expiration / J j Title :.. " �� .Permit is. Non - Transfers able White copy- HD file; Yellow'copy -Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 _ 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845)2794567 To: PG140 S� �4 e J t 2J I Q Attention: A5l1r�r - L 6& r v 15 �/ < Gentlemen: We enclose( -) copies of .B/W Prints Reproducibles Specifications Memorandum Date: q- -7 —G`f Job No.: - Project �T oS '55 TS. jL 7 Reports .Tracings Copy of letter Description: Revision/Date No. Ot: ti tt Yr, y , - 3— 0:1 �- Lw�s 3t J ret, S � e— e,,, U`C dale Fj YoturMessenger ia: Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Very, ly yours HarrvY:�1ic s Jr., 1':E. PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of H 44A,91, CA11-JfF1- W Located at 9 qs- NY5 k Uqj�;- /� i TN PATTER- O Tax Map # M,19. Subdivision of JA'H cLeE�F- Block f Lot `bit' Subdivision Lot # 9 1 1 Filed Map # 9111 Date Filed Gentlemen: This letter is to authorize " ,kw 1) 9 �J ((--'ti o L6 X m 1W411 4 a duly licensed Professional Engineer )_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnarn Coup pitary Code. IN, Very truly yours, Countersigned: _ W nSigned: P.E., R.A., (Owner of Property) N 6124 Mailing Address , �oFr 1 NPR Mailing Address: State NY Zip W - 4 Telephone: �� 21� ' .4 u CAf-MO, State 1 V Zip Telephone: %4�' A 1A ''4161 Form LA -97 July 14, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Senior Public Health Engineer Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2791003 Fax: (845) 2794567 Email: hnengineer@aol.com RE: Individual SSTS - Van Cleef Estates, Lot # 39 - Name Change 985 NYS Route 311 Town of Patterson P -8 -03 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SF-39, "Preliminary Drawing for Fill Placement Only", dated 07/14/04. 2. Two (2) prints of SS -39, "Proposed SSTS ", dated 07/14/04. 3. "Construction Permit for Sewage Disposal System ", dated 07/14/04. 4. "Well Permit Application ", dated 07/14/04. 5. "Letter of Authorization." 6. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only." We would appreciate your review, approval and issuance of the construction Permit at your earliest convenience. Very truly yours, 1 Harry W. Nicho Jr., P.E. HWN:gav 04- 061.39 i ')(f(.0nc) rl(XX r 1 1. ' a ill 13EDAOOW 3 OEDROO)4 2 I' X ;6'- G' ; It' -3'X l6' -0' g TNAN COUNTY - - HOUSE PLANS APPROiIEH ROOM COUNT 3-� 'BEDROOMS V, nova neilis TO I SIT E� 1 }, " , z , it , „r OH FOR APYRC�VT L PLANS YJS BE Firs F,c•or SIGN 0 W I H G ROOK KITCHEN 2 18 �v UASiER BEDR009 ~- LIVING ROOM. VP • r j 1.O. 3 ��DRooM OX DETAIL OR SErr[fAME,vr F!N/SH•°D GRADE —' S� ZkAO -50L AREA C y�DEP / EAN FiU �i !O PERlORED E AT P /P w w 'VC)S[OPE 1132 1FT •'4 11'12 °CRUSHED STONE P W.4Si/!D GRAVE( U i JO /NT CAP END OF EACH ,(A)TRAL 4'0 PERFORATED J- P/PE(.PVCJ SLOPE 'T /ON -ION TRENCH FANCT 10' '0' •0' U0' 0' 0' 5' 0' 0' 5' tJUTcS I. 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