Loading...
HomeMy WebLinkAbout0192DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.10 -1 -32 BOX 3 rl , III I�yM V I:;; , �V M. oil 1 1 r �T 6 111 Im J '. ju 331 1 . rl ` 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P — /o% e-q' I Located at J Town or Village & cjw� Owner /Applicant Name& �,( ,�, LCe Tax Map C o Block 1 Lot 3 2, Formerly o, J?A, fc-alrr Subdivision Name Subd. Lot # Mailing Address 7�6 Cu b ffr4.0 �R ��A- �/�c.�.� G' Zip D 6 pj Date Construction Permit Issued by PCHD 6 •30 'aj '7 Separate Sewerage System built by Address Consisting of 1 ZS a Gallon Septic Tank and / P Tj Ay-m Wr *- )!�� <ftr c 16 7 z-- Other Requirements: Water Supply: Public Supply Address or: Private Supply Drilled by Address Building Type g yp Wn oV Has erosion control been completed? yer Number of Bedrooms tTep Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 6dt l 1 Certified by�] K ([ k S `. L'�S` P.E. R.A. Address Cj %� �/,,�,,,. R (Design � Professional) 1tl�9 License # CA// `2( 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 revocatioification pr, change is necessary. By: Title: lqkIC Date: 1<2110111 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: So. Quaker Hill Town/Village: Patterson Tax Grid # Map Block Lot(s) 8 Well Owner: Name: Address: Properties East 20 colonial Drive Danbury, Ct. Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 4 0 ft. Length below grade 3812 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel _ Plastic _ Other Joints: Welded X Threaded Other Seal: _X_ Cement grout _ Bentonite Other Drive shoe: x Yes _No Liner: Yes x No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First NONE Yes No Hours Second Well Yield Test _ Bailed Pumped X Compressed Air Hours 6 Yield 10 gpm Depth Data Measure from land surface- static (specify ft) Z0 During yield test(ft) 245 Depth of completed well in feet 245 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 20 6 Hardpan 20 245 6 Shale If yield was tested at different depths during drilling, list: ' Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed Putnam County Certification No. 010 -015 Date of Report 10/1/98 Well Driller (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Nagie KKagg Bros—, Address: 162 Baker Rd. Roxbury, Ct . Signature: 44,yce—.. Date: /C' t White copy: HD File; Yellow copy Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 ` ^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914> 245-2800 Albert H. Padovani, Director LAB #: 93.801209 CLIENT #: 9608 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PROPERTIES EAST LLC _ 20 COLONIAL DR DANBURY� CT 06811 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 08/28/98 05:00 ` DATE/TIME REC'D: 08/29/98 09:00 ` REPORT DATE: 09/03/98 PHONE: (203)-792-4776 SAMPLING. SITE: LOT 10, QUAKER MANOR SAMPLE TYPE..: POTABLE : SOUTH QUAKER HILL� PATTERSON, NY PRESERVATIVES: NONE COL 'D BY: THOMAS SCOTT TEMPERATURE..: < 4' NCTES..�.: KITCHEN ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TAP ~~~~~~~~~~~~~~~~~~�~�~~~~~~~-~~~~~~~~~~ COLIFORM ME�H: MF DATE FLAG PROCEDURE RESUL T NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/29/98 MF T. COLIFORM ABSENT /100 ML ABSENT / 1008 ' 08/29/98 . LEAD (IMS) 1~5 ppb 0-15 ppb 12345 / 08/29/98 NITRATE NITROG 1^83 Ill G/L 0 - 10 / 9139 08/29/98 NITRITE NITROG ' <0.01 MG/L N/A 914'' 08/29/98 IRON (Fe) <0.060 MG /L 0-0.3 mg/l 2037 )8/29/98 MANGANESE (Mni <0.010 MG/L 0-8.3 mg/l 2037 08/29/98 SOD IUM (N=L > 25.0 MG/L N/A / 08/2�/98 pH . 6.4 UNITS 6,5-�.5. 9043 08/27/9G HARDNESS, TOTAL 112 MG/L N/A 08/29/98 ALKALIN%TY (AS 58.0 MG/L ` N/A ` 08/29/98 TURBIDITY (TUR NTU 0-5 NTU COMMENTS: FAX TO 203-792-4776 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE "AS NOT) OF A SATISF�CTORY SANITARY DUALITY ACCORDI THE NEW�YORK STATE � AND FPA FEDERAL DRINKINGWATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb CU LEAD limits for public schools are set at 15 EPA Lead & Copper Rule for Public Systems requires that no more than 10% of thei7 distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, --Ise water treatment must be undertaken to'reduce the waters corrosive potential~ iFe/Mn If both iron �nd manganese are present, � ~ combined shall not exceed 0.5,m' /L, ` their total value . . ~' YML ENVIRONMENTAL SERVICES 321 Kear Street ` yorktown Heights, N.Y. 1059G 245_2800 Albert H. Padov�ni, Director LAB CLIENT #: 9608 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PROPERTIES EAST LLC 20 COLONIAL DR DANBURY, CT 06811 NON STAT PROC ~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: DATE/TIME REC/D: REPORT DATE: PHONE: (203)-792 PAGE 2 ~~~~~~~~~~~~~~~ 08/28/98 05:00 08/29/98 09:00 09/03/98 -4776 SAMPLING SITE: LOT 10, QUAKER MANOR SAMPLE TYPE..: POTABLE diet,the water should : SOUTH QUAKER HILL, PATTERSON, NY PRESERVATIVES: NONE COL BY: THOMAS SCOTT ' TEMPERATURE..: < 4C NOTES...� KITCHEN TAP � COLIFORM METH: NF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD ' Na No limits for Sodium proscribed. Suggest~d 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`SCArE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF T RTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY" ' WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND _EIlXTURES. THE NORMAL RANGE OF pH rS 6.5 TO 8.5. . Hd ' HARDNESS IS DEFINED AS THE SUM OF THE CAL'CIUM& MAGNESIUM CONCENTRA7 ON, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOUR�'E�A,D TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARb WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLI8RAM PER 1 TE� HARD WATER: 140_300 MG/L ' (1 9rain/ga1lon = 17.2 MG/L) `SUBMITTED BY: ` ` \ tor .T.(ASCP) ELAP# 10323 mow' NORTHEAST LABORATORY OF DANBURY 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: PROPERTIES EAST L.L.C. 20 COLONIAL DRIVE DANBURY, CT 06811 CT Cert: PH -0404 NY Cert: 11471 DATE SAMPLE COLLECTED: 10 /8/98 & 10/13/98 TIME COLLECTED: 6:30 P.M.. & 9:30 P.M. COLLECTED BY: T. SCOTT DATE RECEIVED @ LAB: 10/9/98 & 10/14/98 TESTED BY: LAB #11471 REPORT DATE: 10 /15/98 SAMPLE SITE: LOT #8,QUAKER MANOR, SOUTH QUAKER HILL, PATTERSON, N.Y. SAMPLING POINT: KITCHEN SINK SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 6.16 no designated limit Turbidity 0.43 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N Alkalinity 64.0 mg/L no designated limits Hardness 118.0 mg/L no designated limits Iron <0.03 mg/L 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 20.1 mg/L 20 mg/L ** Lead <0.005 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 10/9/98 & 10/14/98 SAMPLE, AS TESTED ABOVE: MOTABLE or MINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) e Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 9 OUTSIDE CT: 800 -654 -1230 PUTNAII COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: fir e� Street Location soa7 -E., © egR htr�.e. 1?d�, — Owner 4,,/g_Sr jg„�jT ,`�r,�2, -; r=��,V Town P--q T y- gE� s,_pa/ Permit # Tlcf I – a s Subdivision Lot it _8 I. Sewaee 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/ wetlands ...... ............................... II. Sewage System a. eptic tank size - 1,000 ... 1 25 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation - water tested ................. 2. Protected below frost .................. ............................... 3. IMinimum 2 ft.Original soil between box & trenches Junction Box - properly set ....................... ......:...............:.:...... I- Length required Length installed 2 2. Distance to watercourse measured t 2 0 Ft.......... 3. Installed aceo ding to plan ......... ............................... '..Slope n cepta 6 1/32" /foot ............. �. 10 ft. 42 p p line - 0Vfoundations.......... 6. Depth of trench <30 inches from surface .................. 7. Roo we or El si � " �• 8. Size o v 4 et r cIe ... 9. De th vel in trench 12" minim P g 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems ize of pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4.. Pump easily accessible, manhole to grade.: ............... 5. First box baffled .................................................... :.... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildinQ a. House located per approved plans ... ............................... b. Number of bedrooms .................. ` � �..... .:........ IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured 0o ft ........... c. Casing 18" above grade ............................ ..................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship 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 & standpipes installed according to plan f. Curtain drain outfall protected & dir -to exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate... .. ; ............................ i. Erosion control provided ................. ....................::......... Rev. 1/97 COMMENTS Form - PUT NAM O� NT1' DI:I'AIZ I MI:1' "I ()Ii IIIIAL "I'II 'I -'I SION OF ENVIRON�E DI` WAL 1-IEALI,I -I SERVICE'S CXARANTEE OF SUBSURFACE SEW'AGE TREATiMENT' SYSTEM Ov ner or Purchaser of Building Ta,: fAap . Block -- - — _ Lot - Building Constructed by Location - Street. Building Type Town/Village Subdivision Name Subdivision Lot # I represent that t am wholly and completely responsible for the location, work- manship, material, consthaction 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 LIealth, and hereby guarantee to the owner; his successors, heirs or assi2ris,, to place in good operating conditicn any part of said system constructed by me which fails to operate for a period of 1�vo years immediately following the date of approval of the "Certificate of Constriction 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 wstem. Dated: Month ( 0 Day t_?=. Year General Contractor (Owner) - Signature Corporation Name (if corporation) ad(Ires: State S i Qnature: fi itle: Corporation Name (if corporation) Address: State form C.S -97 ' PUTNAM COUNTY DEPARTMENT OF HEALTH Divkllaa oQ P5lvbemmeafal HaaN6 Sesvkaea. Caamel, N Y 1OS11 NWIlaw to P-Aile PdsM -/ w CE1 uTrATB orcoMPIAMC E _ CO N. PERM FOR SEWAGE DISPOSAL SYSTEM P� N T Lsxntsd at LA QAkeA At r/� RIO Town or VM%p J .. N ( t A,iCC4'� /1 ?Anrua2 Solid. Lot N Ter: Mop Block Owner /AppYcant None �'� S^ )� �1�j `� uS'� B�owal_ ❑ BevMbn ❑ T Date of Pmvlm Approval Adieaa 11 • u� C) // T.,. ZIP Date_ Subdivision Approved / z/-7 / .S Fee Enclosed ®" Amn„nf- Koo mss. Type Ida(,y Lot Area :C11 31 F01 Sectlon Oady Number of Bednionts Dosllpt Flow G P D '0 PCHD NotlOtatlen le Required When Pill Is completed Sepnestte SetreeeBe Syatess fo oaadat •s;GaUaa Septk Tack erne 67 %tCBf f�fy ✓l �t L�t�; To be coldiacted by AddnmB water SappATt PlrbNc Sapply Prom Afkkreee on !� P4lsafe Sopply DdSoll by Aar. Otber Regatreaamte 1 represent that I am wholly and completely responsible for the design and location of the proposed 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 an regu a ions o • Putnam County. Department of Meelth, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written 'guarantee will be furnished the owner, his successors. heirs or assigns by the builder, that said builder will plea• in flood operating condition any part of said »wage disposal system during the period of two (2) years Immediately following the date of the issu- ance of the approval of the Certificate of Construction Complier ce of the of I system or any repairs thereto; 2) that the.drilled well. described above will be located as shown on the approved plan and that said well will installed h rdan wit standards. rules and regu �Mons of the Putnam County Department of Health. Date � ,� G ' V� 5 P,E. _ RA. - -. l Atltlnfs License No /2a APPROVED FOR CONSTRUCTION: This approval expires two,y, r IF m the date i �edunlonss constru ion of the building has been undertaken and is ►•vOCabl• for cruse or may be am•ntlaf'or motlifietl when consider n sang by t ner of Heatth, Any Change or alteration of eonstruetlen requires a new srmi Ap roved for disposal of domestic u ar age, and or supply only, ReV . r� - 10/88 Date By Title Julius I. Cesare, P.E. 64 Blackberry Drive Brewster, New York 10509 914 - 279 -7115 Oct. 13, 1998 Bruce Foley, Director Putnam County Health Department Att: Robert Morris 4 Geneva Road Brewster, New York 10509 RE: Quaker Manor Lot 8 As -Built Dear Mr. Foley, The following Materials are herewith submitted in request of approval for a Certificate of Construction Compliance: 1. Certificate of Construction Compliance 2. Three (3) Copies of a Two -year guarantee signed by contractor 3. Water Analysis Report 4. Well Completion Report 5. Three (3) sets of As -Built Plans 6. Certified check for fee. Thank you for your cooperation in this matter. Very truly yours, Julius I. Cesare, P.E. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL �� �J PCHD PERMIT # a WELL LOCATION Street Add Ass cC� Town/Village/City Tax Grid Number --Z, 5'- WELL OWNER Name E�°rS~i- Ems! Mailing 712us'1c�i Address 2-6 COIGN 4111c Dh fi rc� p 01—o 6,PW rivate 0 Public USE OF WELL l- primary 2- secondary &MSIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM Q TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT�gpm /# E3 REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGE_Jgal ❑ TEST /OBSERVATION D: ADDITIONAL SUPPLY © DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE CgDIILLED ODRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �5— NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �ga Ally / /9 0 A Lot No. 8 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES No NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST'WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ ON SEPARATE SHEET ,�1 T, (signature) 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 shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril g operations be contained on this property and in such �manner as not to degrade or oth r i conta 'pate surface or groundwater. Date of Issue: 19 174,P-L- Date of Expiration 2.Cj 19_� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller TOPS � FORM 4151 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date IG 2, /9!c Re: Property of W_V_r Rfylt7�, DPIS�UE d % yrn S'C,7 -r. . Located at QuA4cac Ai /I 14- (T) R)I xTol& Section /a Block /. Lot -JO_ _T Subdivision of (?)IAJr,-,. Al -YOA Subdv. Lot # Filed Map # 26 Date 7/o/9e 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. Very truly yours, Signed �- �-- Countersign Owner of Prope ty P.E. , R.A. , 74 Zo Address ID Svc s /74// Address 9i SP 2? 9 1-2115" Telephone Town -3 9 q z-- C�-Zd Telephone PC-1. ' P U T N AM COUNTY D E PA R T M E N T OF H E A L T H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 20 LO/0-Y1.41 Petal � a (envy. 2. Name of Projector -.4— R"' Sp 3. Location T /V /C: 4. Project. Engineer: J h,f �� *Z19- 5. Address: Arz-#-a4 " License Number: Phone:'Z?q -7/ "5"- 6. Type of Project: X Private /Residential Food. Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? /�4 9. Has DEIS been completed and found acceptable by Lead Agency? -. 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? Date Granted: —` 14. Type of Sewage Disposal System Discharge...... Surface Water v� Ground Waters 15 If surface water discharge, what is the stream class designation ?........ _ 16. Waters index number (surface) .......................................... 17. Is project located near a public water supply system? a �8. If yes, name of water supply Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... A- '0. Name of sewage system Distance to sewage system 1. Date test holes observed �7- 22. Name of Health Inspector: )VEX 73. Project design flow (gallons per day) ...... ............................... 11/93 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. X 25. Has SPDES Application been submitted to local DEC Office? ............... ..- 26. Is any portion of this project located within a designated Town or State ^/ wetland? .................................. ............................... ° 27. Wetland ID Number ........................ ............................... 28. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? ................... 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or I/ any other potential known source of contamination? ..YES or NO DESCRIBE: 32: Is there a local master plan or file with the Town or Village? ........... 4/4, 33. Are community water, sewer facilities planned to be developed within 15 years? /I14 34. Are any sewage disposal areas in excess of 15% slope? ....... �o 35. Tax Map ID Number ......................................................... 36. Approved Plans are to be returned to: ................ Applicant Engineer if the application is signed by a person other than the applicant shown in Item 1, the 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 Hisdemeanor pursuant to Section 210.45 of the Penal Law. ,. _ IGNATUP,ES & OFFICIAL TITL 'AILING ADDRESS: r� RnNAM OOUI rY DEPARTMENT OF HEALTH DIVISION OF ENVIRUZUWAL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM OOUNTY HEALTH DEPARTMENT TO: Ccamissioner of Health In the matter of application for: J ' represent that I am an officer or employee of the corporation and am authorized to act for li1�41i /%%- �%Li/> Z-- G C--" (Name having offices at Whose officers are: President: Name and address) Vice - President: (Name and address) Secretary: (Name and address) Treasurer: (Name and address) r""o' 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 me this .2 da Signed t of -7 Title: Corporate Seal 9C `JA `,4- 4 - MATi.6 2 PEILCOT.ATION TEST. DATA T6C) i rT"r - ;o1J DATE �t )3 - .7 BY Inspactor . ��r� 'Porvze 7_ s Lot No. Teut Hola Ton t. Hold Soil. Typo Soakad the atandar No. DeRth '�c rect. OfNEwY P�Q �J Dated: 3 gnacure , a. License loo. (p .E ... No. ' s 4112 A N P ROFESSIO TEST RUNS the undorsigned, certify -that these porcolation to Ware done by myself or undo according to the atandar n. Tha $diita and results presenta � r Tr qF '�c rect. OfNEwY P�Q �J Dated: 3 gnacure , License loo. (p .E ... No. ' s 4112 A N P ROFESSIO I)I�iJ:i�(: {'! (il' I:i:vJJ�►:•St'?�•li:l. I:! \IMS: W iT)UCSSCD . BY M E L P. pls�iCIJ INVIA S.1L= --SU UL:7% : E -JAZ . DISPOSAL S1S *Vi`1 i� �].G M. owner I..OFT Cor,P, /,TohN FoRr:.9 A.odress Lo,=t':-d at (SL--e--t) H!" JgOD D SC--. Block Loc (inclim to nearest cross street) 4. ..Ga�P01igrF. Gip 7 c= SEAL 1980 Flocsll N •,C E :.r : r+.ww..• �� 411.x`' ' ��� SS 01,,r,\_ 1_ Mass to be reo�t:e3• at s� deotl� until ao_ormimrztely equal soil rat, are obtainc6 at .:ach percolation Lest bole_ All data t:o be sulmitted Lor revic.:_ 2_ Dc?ch nra,urc- :tz.-:t- w t-c nLCe. Lrcn trop of hole_ M.t1t1SC03.L1ty i-= -Li-k DA S U pfD I V I S I N wZt=- ''S1]e:l Cl** \o 1 o lV 3. CJ]� P-c---r -;'ZIC Caz'N RSC; LXD :TO EC supla"I D W'= APPM MCNS . D2te cf .P- -e- Soiking: ' . 7�a gey lkte of Pe colaticn Tess 7 ;'Vrl BOL 21L "� CrAC•i TLME : PCt00LA=CN P RM . ElPwz_ Dr?tR too i F_'c:li G�•er revue 210 Z'z�e .. Grcum Sur-_ `` Inches' Soi? St rt SHOD DrCa In M12I/T� DLCO . ISI4'�1e5 InCles La:a7 !'ot59 3ar�r ay4 Soy �y: 5.3 DRY �I V i a al /� ~;L3'f�`� 7 s ,... y /y 7 /Y a7r►:04 �33/y �s3 yay d133%y 4. ..Ga�P01igrF. Gip 7 c= SEAL 1980 Flocsll N •,C E :.r : r+.ww..• �� 411.x`' ' ��� SS 01,,r,\_ 1_ Mass to be reo�t:e3• at s� deotl� until ao_ormimrztely equal soil rat, are obtainc6 at .:ach percolation Lest bole_ All data t:o be sulmitted Lor revic.:_ 2_ Dc?ch nra,urc- :tz.-:t- w t-c nLCe. Lrcn trop of hole_ `t 2 3. 4. ..Ga�P01igrF. Gip 7 c= SEAL 1980 Flocsll N •,C E :.r : r+.ww..• �� 411.x`' ' ��� SS 01,,r,\_ 1_ Mass to be reo�t:e3• at s� deotl� until ao_ormimrztely equal soil rat, are obtainc6 at .:ach percolation Lest bole_ All data t:o be sulmitted Lor revic.:_ 2_ Dc?ch nra,urc- :tz.-:t- w t-c nLCe. Lrcn trop of hole_ Tl= PIT DATA itf'WIA( W 'IV 1% SUrMIZTID KUM APPLICATION--,. ti;,,• :. D�'TION OF SOILS ENCIO MERM IN TEST HOLES HOLE NO NO HOLE NO. b • • ,HOLE .. 1 ' Top '50 Ol 2' 30 G 4' 5' , ; k► •6' 7' : 8' :10' =' t_ `other. . `1�ddress' THIS SPACE FOR USE By Soil Rate Approved SEAL 1980 sq.ft /gal. Checked by Date `_ New York City Department of Environrnonial Protection D1 "P Julius Cesare, P.E. Blackberry Hill Brewster, New York 10509 Dear Mr. Cesare: TEL 110: May 10, 1994 Re: Quaker Manor SSTSs (T) Patterson, Putnam County Bureau of Water The Department has inspected the deep boles, witnessed the percolation tests Supply & Wastewater and inspected the sites for ten proposed individual subsurface sewage disposal systems Collection (SSDS) for the proposed project. The lots are shown on the site plan labeled Final Plat Quaker Manor and dated 4/4/94. T"ne ten SSDSs for lots 1 - 10 meet the requirements of 10 NYCRR Appendix 75 -A. The tent sites as located on the Final Plat are approved Sources Division for SSDSs. Requirements for final individual SSDS drawings for construction approval (914)742.2012/3 will follow shortly. Division of Drinking Should you have any questions, please call: 914 - 742 -2065. Water Quality Control (914)742.2080 Sincerely, 465 Columbus Ave. Suite 350 - - -- Valhaila, New York 10595• \ 1336 :W. tRoberts, Ja s P.E. Program Engineer Commissioner xc: Town of Patterson Planning Board Putnam County Department of Health RICHARD D. GAINER, P.E. Depaty Commissioner Julius I. Cesare, P.E. Blackberry Hill Brewster, New York 10509 914- 279 -7115 May 15,. 1996 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 a11.10 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 DatePrL /L Re: Property of Located at 9o,4'44 C'JUA4gr_t Ai /I /PA (T) P,�� TO.* Section_X /a Block /. Lot 2 S- Subdivision of.. MuA4!­ 1&"YCA Subdv. Lot # ep' Filed Map # Gentlemen: Date 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. , 2_ Address _d12, Telephone Very truly yours, Signed Owner of Prope_ ty '2 s-, CAL,; Address ✓PA2= Town Telephone SSDS DESIGN REPORT QUAKER MANOR SUBDIVISION LOT # 8 QUAKER MANOR SD LOT # 8 4 Bedroom Design Design Flow: 4(200 gal /bed) = 800 Gallons Perc Rate: 21 -30 Application Rate: 0.6 Req. Area: 800/0.6 = 1333 sq. ft. Req. Field Length: 1333/2 = 667 Septic Tank: 1250 gallons RLI: 647.0 Use 14 lines, 48' long each System and Expansion 1.0 feet Fill Required PUTNAM COUNTY DEPARTMENT OF HEALTH I DIVISION OF ENVIRONRENTAL HEALTH SERVICES AFFIDAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Cammi.ssioner of Health In the matter of application for: represent that I am an officer or employee of the ;6rpoiiation aAd am authorized to act for (Name having offices at- 20 , .Whose officers are: President: (Name and 4ddress) Vice - President: (Name and address) Secretary: (Name and\address) Treasurer: (Name and addre,�- 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 me this Signed. Title:!- �--, Corporate Seal 20 APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION NAME OF OWNER BY B. HEDGES R.MORRIS OTHER DATE DOCUMENTS. Y Prl PERMIT APPLICATION = PC -1 = WELL PERMIT = PW S LETTER = ENGINEERS AUTHORIZATION m DE . SHEET(DDS) m RPORA SOLUTION A®t' m P REE SETS = HOUSE PLANS - TWO SETS = VARIANCE REQUEST SUBDIVISION gyp, = LEGAL SUBDIVISION = SUBDIVISION APPROVAL CHECKED = PER no �* L RD DEPTH = CU IN DRAIN REQUIRED =STANDPIPES tr ®m a Y TAX MAP # AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE. MPEEDD P& D BOX SHOWN & DETAILED BEDROOMS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM ROPERTY METES & BOUNDS USE SETBACK NECESSARY (TIGHT LOT) H-JJSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS D<r-LAYBARRIER L�W'JoFr HORIZONTAL: SLOPE 3:1 TO GRADE UZ FILL SPECS = FILL NOTES ILL CERTIFICATION NOTE EPTH GAUGES K nm L PROFILE & DIMENSIONS LUME GENERAL W IAPPROVAL SSDS ADJ. LOTS FILL IN EXPANSION AREA TLAND ( TOWN/DEC PERMIT REQ ?) TRENCH DATA ON DDS PLANS & PERMIT SAME F TRENCH PROVIDED =60 FT MAX - 1969 - NEIGHBOR NOTIFIFICATION ARALLEL TO CONTOURS ,- ER BI/ZBA 100% EXPANSION PROVIDED w 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS FIELDS SEWAGE SYSTEM PLAN - (NORTH ARROW) = 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL S HYDRAULIC PROFILE = GRAVITY FLOW = 20' TO FOUNDATION WALLS 15' WELL TO P.L NSTRUCTION NOTES (GRINDER NOTE) = 100 TO WELL, 200' IN D.L.O.D., 150' PITS DESIGN DATA: PERC AND DEEP RESULTS = 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 9�O -FOOT CONTOURS EXISTING & PROPOSED = 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER VEWAY & SLOPES CUT = 10' TO WATER LINE (PITS -20') FOOTING /GUTTER/CURTAIN DRAINS = 50' INTERMITTENT DRAINAGE COURSE F�SEROSION CONTROL; HOUSE,WELL, SSDS = 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE = 15' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% FRC & DEEP HOLES LOCATED = 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS, PRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK LOCATIONMAP =10' FROM FOUNDATION; 50' TO WELL COMMENTS: N4125'35 "E 31.24' _ N54'42'33 "E 40.00 0 N49'13'58"E 48.34" s i LOT NO. 7 QUAKER MANOR SUBDIVISION FILED MAP NO. 2678 1orb.k_ ��' G 0�2 STORY FRAME UNDER CONST. AREA = 5.37 ACRES + \— \ R =325.0' ty L =49.60'38 "\ � L =49.60" Op LOT NO. 9 QUAKER MANOR SUBDIVISION FILED MAP NO. 2678 ryo CERTIFIED TO: 9 Re25.0' 1. PROPERTIES EAST LLC. �sT•os'a' L =29.28' 2. M & T MORTGAGE CORPORATION 3. FUTURE TITLE COMPANY 4. NOTES 1. BEING THE SAME PARCEL AS DESCRIBED IN THE LEIV? 6. CERTIFICATIONS INDICATED HEREON SIGNIFY THAT _ OF DEEDS, AT PACE _— AND SUBJECT TO THIS SURVEY WAS PREPARED IN ACCORDANCE WITH RESTRICTIONS AND CONDITIONS THEREIN. THE EXISTING CODE OF PRACTICE FOR LAND SURVEYS 2 TOGETHER W17H ANY RIGHT, TITLE OR INTEREST IN ADOPTED BY THE NEW YORK STATE ASSOCIATION OF AND TO THE CENTER OF THE PUBLIC ROADS SHOWN PROFESSIONAL LAND SURVEYORS SAID CERTIFICATIONS HEREON. SHALL RUN ONLY TO THE PERSONS FOR WHOM THE J. BEING LOT NO. 8 AS SHOWN ON FILED MAP NO. 2678. SURVEY IS PREPARED, AND ON HIS BEHALF TO THE 4. UNAUTHORIZED ALTERATION OR ADDITION TO A 77XE COMPANY, GOVERNMENTAL AGENCY AND LENDING SURVEY MAP BEARING A LICENSED LAND SURVEYORS INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES SEAL IS A WOLA77ON OF SECTION 7209, OF THE LENDING INSTITUTION. CERTIFICATIONS ARE SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR LAW. SUBSEQUENT OWNERS. I9 9 Re25.0' � �sT•os'a' L =29.28' 1\,0 / .A`OI .a°7' �' LOT QUAKER MANS FILED MAI MA. QUAKER 1 TOWN OF PATTERS SCALE: 1" = 100' FOUNDA TION DAY, OSNALD & % .,Z N 9 Q / Q / 0 0 o, o, M 7I 1 j ,95•A9 °- i LOT 8 TABLE OF DISTANCES AC 27' BC 47' AD 35' BD 53' AE 41 ' BE 57' AF 47 BF 62' AG 52' BG 67' AH 59' BH 72' AI 64' BI 74' AJ 53' BJ 90' AD' 57' BD' 92' AE' 60' BE' 95' AF' 64' BF' 98' AG' 69' BG' 100' AH' 73' BH' 103' AI' 77' BI' 107' AK' 60' BK' 98' AM' 64' BM' 101' AN' 68' BN' 104' AO' 72' BO' 106' AP' 76' BP' 1091 ;A4' 80' BQ' 113" -AT' 83' BT' 114' AL 105' .BL 144' ;AM 108'. BM 146' 'AN 1101 0' BN 147' AO 112' BO 148' .AP 114' BP 151' A4 116' B4 152' .AT 120' BT 156' iAR 56' BR 94' 'AS 29' WS 23'