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HomeMy WebLinkAbout0186DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.10 -1 -26 BOX 3 IM. i - rr 1 r 16 4 �� -� dr R, •. PiJ'I'1vAM COUNTY DEPARTMENT OF HEALTH YiYVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P Located at S1 LzJ1Z Qu ctesJ - Town or Village LA—Tit-vil cf'y Owner /Applicant Name WETr �r ' A— us'�Tax Map V, Tax —� ^ ZLot Formerly Subdivision Name Mailing Address 2-0 G Lo w Date Construction Permit Issued by PCHD Subd. Lot # 2 >S c�' !% Separate Sewerage System built by n W nxev*'- Address Consisting of 2 5_6 Gallon Septic Tank and Other Requirements: Water Supply: y o cs Zr- 'r7_" —c1WP Public Supply From Address ._ Zip V 6 0}- 6 / xor: Private Supply Drilled by COX D Ae :Fe ih�* WWca• Address /tP At ,.Building Type Won19 .C_ Has erosion control been completed? Y&-T Number of Bedrooms 154- Has garbage grinder been installed? /ter I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Date: 06 2& 19 97 Certified by Address County Department of Health. P.E. R.A. Professional) tL- — o01 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 water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when,:-in the judgment of the Public Health Director, such revocat1*9n,,Todification or change is necessary. By: %/ Title: Date: W 3 i White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM West - OUT Owner or Purchaser of Building Building Constructed by — to - / ,2_ Tax Map Block Lot PAT I S v 6e Town/Village Location - Street Subdivision Name WC) 2 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described. 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 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 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 system. Dated: Month i i Day ( Year Signature:( ti �{ s L L Title: t1j 4�2, General Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: �o ��., �r,,,� , j�dL Addres : 2n�,�D1i' State k� C Zip d61-11 State e fi Zip Form GS -97 Envird%st lim, L.aborat(xts kx. ANALYTICAL REPORT ;:.paDf'�RrIS BAST. LLB 20 GOl4NIAL fit. NY50pf1 10142 N)Qcp 1x607 OTDON6 "-0654 ! *A W0e4 315 Fullortor Avonuo Nt burdn. NY 12660 (9141562 -0800 FAX (014) 662.0641 Da Client Name: ETL Sample Number: Client I.D.: Date Collected: Date Received: Comments: Analysis Federal Id: Collected by: Inorganics Analysis Data Sheet Form 1 • IN PROPERTIES BAST LLC 177682.01 97.9297 LOT 2 QUAKER MANOR S, QUNLEY HILL 10- OCT -97 10- OCT -97 PATTERSON Result Units Projcct NW: STANDARD Matrix:. 1 DrinkH2O Method Analyzed :. ,., ; .........:::.:: -.:: Ali NT.,.;:.:.....:.::.......;.: , ...,_. /1U0..i1LS :.......... _.........:::iIY2U' +17 QG ; • ::.................:..:::::: Total Coliform ABSER /100 MLS 9223 10-OCT-97 Remarks; Sample passes NYSDOH drinking water standards, $15 Fuoartun Mona EnvWoTest 0! 914) 602- NY 12660 Laboratories W. —. __. FAX (n14) SAP nae, WODDH1ou2 WDEP7WI CTDDiiGNt&U MANY049 --- --------- - - - - -- ------- - - - - -- Renowd._._ ❑ RevLbo p Ownsx /AppYaot Nms' c t`f PAS % /l t /7"7 `-2 Date of Psnvleas Approval Ma9bt Addtuss l Cc %O /P 1,4-e be 0 OA—yea, , C D6F-11 Town 22P Date Subdivision Approved Fee Enclosed Amnnnt- _7041 Bell Type Wow ra �? Lot Agee � ,S O � � D-Pm Voldoie Nuo'bae d Hethusaas Doaigit Flow G P D CEO o PCHD NoWksdon Is Rogabvd- Wb� FIR Is oompleied separate Sevrom a Systes fe cessiM d 2� C*@0= Sepd c Teat -ad _ 90 o' 2—AF?y -lC _ _ LAae /d ,!b_ L_ F 45.p s To be aesksa tad by AtMtess Water SUr*. PqM Supply Fm- Addm a can Ps9vate Sappty OrMad by ---Adams Odwr Reoalrommts 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 3) that th separate sew disposals stem above described will.be constructed as shown on the approved amendment there to and in accordance with the itandards, rules a regu urns 07 nam -County Department, of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to, the Commissil of Asshhwill be submitted to the Department, and, a written guarantee will be furnished tits owner, his suc6suors, heirs or assigns by the bulkler, that said builder will Owe in good operating condition any part of sold sewage disposal system during the period of two (2) yews immediately following thedate.of the iau- ante of the approval of the Certificate of Construction Compile of the orig, I system or any repairs thereto; 2) that this drilled web descsibipa above will be located as shown on the approved plan and that said well will stalled in. rdan _ wit standards, rules and requ a�UMn's of the Putnam, County Departtent of Health. Date ess r Sign ed RE. _ RA Addr License No 'APPROVED FOR CONSTRUCTION: This approval expires two yea s fr m the date issued- unless, constru on of the building..Nas ben urxlartaken and is revocable for cause or may be amended or modified when consider assary by the Commissioner of Health. Any charge or - alteration of construction requires a new pe mit. Approved for disposal of domestic sanitary sewage, a ly only. 188 Date _L= By PUTNAM COUNTY DEPARTMEff OF HEALTH Divisions of Env6+amstol Health Seevkea. Carmel. N.Y. 16512 Rambseer to Paovmo Penult an CERTIFICATE OF COMPUANCB CONSTRIICTION PE mrr FOR SEWAGE DLSPOSAL SYSTEM Psemk p lac r/Z 9 P afed at _ C,n r: ,�r Cat, ,,.,�,�vt P To u.,a or Vm.Re 9abdirld.a Nalaae rS CS %•�L� C� l MANu/�_ �t /� Se6a. Lt P T" Map B6& Eeelewai—o Yev4{ea ❑ Date of Previous Approval Manus %o -v IA-,e / hN�i cat � — O65�--# Town ZIP Date Subdivision Approved jZ /:zA5- Fee Enclosed Amn„nt Tod Building Type W600 I ii0 ff-IP09DI-fodfleation eedon Odr Depth Volume Number of Beirooaus T Design Flow G P D t O Is Regoleerl When FM Is completed Sepersde Sewerage System >r osedst of Z�d Galloa Septle Teak aaa 900' '9F1YC9 LE�eiJ; R c � 61 r To be coostructed by water Supply.— Supply Prom Addtees on pefeaee Supply Milled by —Address Otter Reootremeoto 1 represent that 1 am wholly and completely responsible, for the design and location of the proposal sYstem(s); 1) that the separate sewage disposal system above, described will be constructed as shown on the approved amendment there to and in accordance with the standard; rules and regulations of • Putnam 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 heirs or assigns by the builder. that Yid builder will Piece in good operating Condition any part of said sewage, disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Complle of the, origi 1 system or any r.pairs thereto; 2) that the drilled well dewibod above will be Misted as shown on the approved Olen and that mid well will stalled in ortlan wit ,standards, rules and rpu ions of the Putnam County Department of Health. Date,Datern�2 / ",� Signed P.E._ R.A. ���Address – �l_ic•nse, No�Z� APPROVED FOR CONSTRUCTION: This approval expires two Yeas 11 m the date issued unless constructln of the building has Dean undertaken and is revocable for cause, or may be amended or modified when consider essary by the Commissioner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage. and /or private water supply. only. Rev. 10/88 Oat• her Title �F 2 ffi J� a -< W `io WILL UUP1rLL11UN t:cr•rUNL DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOUAESS: TOWNI VIL / 1 I Y TAX GRIO r+UA18ER: sp, N 1Lj_ Ai91TERScx1 MOP ff , .. -C.OT WELL OWNER NAME. ADDRESS: I•OFr e0A1s7- ,elJGT /On/ IMP /4OUSE- /P1) .�REdc,�T�.� /�!. �PBI ATE PUBLIC USE OF WELL 1- primary 2 - secondary �K RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM O TEST/ OBSERVATION ❑ OTHER (specify) p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 9pm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE .526 gal. REASON FOR DRILLING ,REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY ANEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH _ �z_f ft. STATIC WATER LEVEL rs ft. DATE MEASURED '/—/0 " DRILLING EQUIPMENT ❑ ROTARY W COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING OOPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS .TOTAL LENGTH 60 tL MATERIALS: XSTEEL ❑ PLASTIC O OTHER LENGTH BELOW GRADE ft. JOINTS: O WELDED tKHREADED ❑ OTHER DIAMETER in. SEAL: OCEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT lb. /ft. DRIVE SHOEOYES ❑ NO LINER: CJ YES 01110 SCREEN DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST O YES ONO HOURS — SECOND GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP OEM tL BOTTOM DEPTH ft. WELL YIELD TEST ' It detailed pumping t ME_DiOD: O PUMPED tests were done is in- t COMPRESSED AIR , formation attached? !J BAILED O OTHER ; ❑YES ONO 1�lELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE Water Bear- ing Welt Dia- meta in FORMATION DESCRIPTION coat ft. ft WELL DEPTH IL DURATION hr. min. DRAWOOWN ft, YIELD gpm. Land lce 43S C.49 5 / ,8/20LtJit1 SC 5 CA SCW/sT /4/»S M /CA SCH /ST WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES O NO ANALYSIS ATTACHED? O YES O No STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE ILMADER K OEL CAPACITY DEPTH VOLTAGE HP WELL ORILLER NAME .BO�/v A/ CIJELL CO.M1VC DATE 4 �p ADDRESS �D S /PO U�S� SIG rrkTURE / ti' J/ b9 1, _ 11A)"10`94 17:41 If':id-TEF' New York City Department o1 Envlronrnontal Protection Bureau of Water Supply & Wastewater Collection Sources Division (914) 742.2412/3 Division of Drinking Water (�uallty Control (914) 742 -2090 46S Columbus Ave. Suite 350 Valhalla, New York 10595. 1336 Commissioner RICHARD D. GAINER, P.E. Deputy Commissioner DAP Julius Cesare, P.E. Blackberry Hill Brewster, New York 10509 Dear Mr. Cesare: TEL I I' =i: _ _ 1 ; - ._,!ti_r a'-' I F'i_t i May 10, 1994 Re: Quaker Manor SSTSs (T) Patterson, Putnam County The Department has inspected the deep boles, witnessed the percolation testis and inspected the sites for ten proposed individual subsurface sewage disposal systems (SSDS) for the proposed project. The lots are shown on the site plan labeled Final Plat Quaker Manor and dated 414194. The ten SSDSs for lots 1 - 10 meet the requirements of 10 NYCRR Appendix 75 -A. The ten sites as located on the Final Plat are approved for SSDSs. Requirements for final individual SSDS drawings for construction approval will follow shortly. Should you have any questions, please call: 914- 742 -2065. Sincerely, Ja s W. Roberts, P.E. Program Engineer xd: Town of Patterson Planning Board Putnam County Department of Health Julius I. Cesare, P.E. Blackberry Hill Brewster, New York 10509 914- 279 -7115 May 15,, .19916 Bruce Foley, Director Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 Att: William Hedges RE: SSDS Quaker Manor Lots 1 -10 Dear Mr. Hedges, We are herewith transmitting completed construction permit submission packages for the above noted 10 lots of the Quaker Manor Subdivision. This letter will serve as a transmittal letter for all 10 submissions. A copy of the letter will is included in each of the submission packages. In accordance with department requirements we are submitting the following: 1. A completed Construction Permit Application. 2. A letter of authorization for the Engineer for each lot. 3. A corporate resolution for each lot. 4. An Engineers Design Data report for each lot. 5. Three sets of plans sealed by the Engineer containing all the required data as outlined in the Departments policies. 6. As these lots are being sold unimproved but with SSDS Approval, we are not submitting specific house plans for each lot. Be advised the.Lots 1 -8, and 10 are designed for four bedrooms and lot 9 for three bedrooms. We will advise buyers by providing copies of this letter that they are to provide you with house plans before start of construction. 7. We are providing Well Permit Applications on lots 1, 3, 4, 6, 8, and 10. Wells already driven page 1 Will be used on lots 2, 5, 7 and 9. Logs of these wells are herewith included. 8. A certified check in the amount of $3,000.00. to cover the combined fees on all 10 lots is herewith included. The field data for lot 5 would indicate that no fill is required for the system design and a two and one half foot fill required for the expansion design. The plans are presented as such, however the toe of slope for the expansion fill will encroach upon the now to be constructed system. The two options are to build the system in fill or to request a waiver for construction of the expansion fill at this time. As the deep holes in the system area show more that sufficient depth it would not be good engineering judgment to construct a fill. We are therefore requesting a waiver of the requirement that the expansion fill be constructed at this time. Please be advised that during the course.of the subdivision design representatives of the NYCDEP did visit the site, review all available test data and determine what additional testing would be required. All that testing was completed and witnessed by them and again by your department. A copy of the NYCDEP letter is herewith included in-each of the submittal packages. Thank you for your cooperation in this.matter. Very truly yours, Julius I. Cesare, P.E. page 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date �P2 /L 2, /9 9c< .... ................ ......... Re : Property of c--Ti E74ST C L7z, us � d a 7vPI S' C'7 r Located at Ro�ztA Qy,q f�i /I /,-P. (T) "so,y Section /o Block /. Lot 2 5' Subdivision of f�u,or ,. R,4-yoA Subdv. Lot # Z Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer `� or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with, this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersign P.E. , R.A. , 26 &.eec S /'4 // Address 2O rd. : l& p 6 9 Telephone Very truly yours, Signed Owner of Property '2J C �:% -Ito- p F Address Town 7 <2 "� 7 7,� Telephone SSDS DESIGN REPORT QUAKER MANOR SUBDIVISION LOT # 2 tLerI %JA.A 1.1 PUrNAM COUNTY,DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: .Ca mnissioner of Health In the matter of application for: I. -o.-, jc Pte' represent that I am an officer or employee of the y- orpomtion ar�d am authorized to act for tFu - -�,,�c mot'' -}— Gt AO "% £� - /�✓�`,D L L C (Name of Corporati n) having offices at 20 Cm /o.v `r Z /Lc Whose officers are: President: ( Name and sd&es s ) Vice - President: (Name and address) Secretary: (Name and \address) Treasurer: (Name and addr6is }. ` and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before - .. • /s �I —� Signed- °_...�° -3� Title: e6g��� corporate Seal 20 QUAKER MANOR SD LOT # 2 4 Bedroom Design Design Flow: 4(200 gal /bed) = 800 Gallons Perc Rate: 45 -60 Application Rate: 0.45 Req. Area 800/0.45 = 1777.8 Req.Field Length: 1778/2 = 889 LF 2' Trench Actual 900' Septic Tank: 1250 Gallons Dosing Required Dosing Volume: (pi)(2/12)2(900)(..75)(7.5) = 441 Gallons Dosing Chamber: SC 6 x 6 380 E = 28" RLI: 762.0 Use 12 lines, 75' long for each System and Expansion APPENDIX C FINAL SITE INSPECTION DATE: S Y -� Inspected by: STREET LOCATION y �` `��+�i u� % c ��� OWNER PERMIT # TM # OR SUBDIVISION LOT # L.o Y'-10- f -? I. SEWAGE DISPOSAL AREA YES NO COMMENTS a. SDS area located as per approved tans b. Fill section - date of placement 2:1 barrier LGTH WIDTH AVG_DPTH c. Natural soil not st d. Stone.brush.etc..gr e. 100 ft. from water II SEWAGE DISPOSAL SYSTEM a. Septic tank size - b. Septic tank install c. 10' minimum from fo d. DISTRIBUTION BOX 1. All outlets at s 2. Protected below 3. Minimum 2 ft. or e. J FICTION BOX - properly set f. TRENCHES 1. Length required - 77 5 Lei 2. Distance to watercourse measured 3. Installed according to plan 4. Slope of trench acceptable 1/16 - 1/ 5. 10 feet from property line - 20 feet 6. Depth of trench < 30 inches from sur 7. Room allowed for expansion. 100% 8. Size of gravel 3/4 - 1;" diameter cl 9. Depth of gravel in trench 12" minimu 10. Pipe ends capped g. PUMP OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pura easily accessible manhole to-gr 5. First box baffled 6. Cycle witnessed by Health Department estimated flow Der cvcle tested .� v ox and trenches h installed ft. 2 "/foot - foundations ace P✓ III. HOUSE a. House located per a roved plans b. Number of bedrooms IV. WELL a. Well located as per approved plans b. Distance from SDS area measured ft c. Casing 18" above grade d. Surface drainage around well acceptable V. OVERALL WORKMANSH I P a. Boxes Properly grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backfill material contains stones < 4" diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir to exist watercourse g. Footing drains discharge away from SDS area h. Surface water protection adequate i. Erosion control provided 1,o c- .. 'rsjed 7 S7 by Ts. ;Z -V-7- --7--/ _ some- PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Simmons, M.D. Commissioner of Health - FIELD ACTIVITY REPORT - U Sheet of Orig. Routine Orig. Complain Orig. Request ____ Campl iance _Taint Comp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference Other Explain / Signature and Title PERSON: IN CHARGE OR INTERVIEWED: 1ackhdwledge this Field Activity Report. SIGNATURE: TITLE: TELEPHONE: g7S-zri,rd exj,o7Gi i G I .ti. t ULIl1S I® CESARE5,P E TABLE OF DISTANCES AC 50' AC' 126' BC 77' BC' 141' AD 57' AD' 131' BD 84' BD' 146' AE 65' AE' 134' BE 92' BE' 152' AF 73' AF' 139' BF 100' BF' 157' AG 83' AG' 145' BG 110' BG' 164' AH 94' AH' 151' BH .120' BH' 171' AP 17' AI' 197' BP 32' BI' 208' AO 36' AJ' 199' BO 50' BV 211' AR 100' AR' 203' BR 115' BR' 216' AI 110' AL' 206' BI 126'" BL' 220' AJ 113' AM' 213' BJ 131' BM' 226' AR 119' AN' 217' BK 138' BM' 232' AL 124' BL 144' AM 132' BN 1.52' AN 140' BM 161' .ti. t ULIl1S I® CESARE5,P E