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PIUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT .91
Located ats, Qr,44' EMi/ PD Town or Village
Owner /Applicant Namejn6�a1I-T Tax Map Block % Lot % 7
Formerly
Subdivision Name Qu Ages 1W4At -6'<'
'Old 7f6 t., Sce-11-- Subd. Lot # 149
Mailing Address 2D Ce o ymk VA Zip 0 �'8-//
Date Construction Permit Issued by PCHD 7 --2 9:7
Separate Sewerage System built by
Address
Consisting of /Z5-0 Gallon Septic Tank and `' 2- `( � Ca e,?'' 100-7-d 11 -Mlyx-
Other Requirements: f ) o c. ,tee c Cie, -. t f a--
Water Supply: Public Supply From Address.
or: Private Supply Drilled by
Address
Building Type a c�� Has erosion control been completed? Sf 63
Number of Bedrooms T 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: Y Certified by a s C P.E. R.A.
Address
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 ar ject to modification or change when, in the judgment of the Public Health Director, such
revocatio o ' icatio r change is necessary.
By: Title: Date:
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
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # " 2/ '91 .
Located at S, O(j44o. k 1l )Q D Town or Village PAPt s 0 y
Owner /Applicant NameWEq- afT JJ_C Tax Map Y Block / Lot /7
Formerly
-old w
Mailing Address
Subdivision Name �% Aggil /W4^ts ,
Subd. Lot # /0
Date Construction Permit Issued by PCHD 7 �7
Separate Sewerage System built by
Address
Zip D 4'8-//
Consisting of /7-570 Gallon Septic Tank and 12- `"1 Ca j�g'' b'Ze ` 'f a4YK
Other Requirements: f) 0S4,,c C 4A,!!,11e&
Water Supply: Public Supply From
or: _ Private Supply Drilled by
Address
Address
Building Type We Gb Has erosion control been completed? ges
Number of Bedrooms 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: Y Certified by�.Jcr lrfit P.E. R.A.
Address
# MZ4
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
revocation, modification or change is necessary.
Title:
Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
'x`3/94/19981 12:20 9141453170 YORKTOWN NiEDICAL LAB
PAGE el
YML ENVIRONMENTAL SERVICES
SE1 Kean Street'.
`'orktown Heights, N.Y. 10598
(?1.4) 245--2800
Albert H. Padovani, Directa; -.
LAB # 93.0010-0'? CLIENT #1 9608 NON 3 TAT F RtOC PAGI
----------- -------------- fV ----- N(Yn..Mry
F•RQPEF; T I ES EAST LLC DATE ,TIME TAK IFN-, 08/26/98
20 COLONIAL DR DATE /TIME RECD: ,78/29/98
DAN8URY, OT 06811 REPORT DATE: 01' /i.1 3/99
PHONE. (203) -7 ?2 -4776
SAMPLING SITE > LOT 10, QUAK'ER MANOR SAMPLE. TYPE—: PO'
SOUTH QLJAVI R HILL, F'A'T T'ERSON, NY PRESERVATIVES: P401
COLD BY: THOMAS SCOTT TEMPERATURE...' `.
NOTES...: k:ITCHEN TAP( COLIrORM METH; Mr
!.1!L'M1'NA(Nh'rvn(NN rvNNMI KNNM1•M1'N/.r /.IV N--- ----- NNf..'M1'N.�r .vNN.`+�NN N.MINII'M1•M1'NNNN�(rrNNry NrvNNlr ry 1. nr lv !•�
DATE FL AO
FRU - ,EDURE
RE =SULT"
NCRMAL - •ANGE
ME
PUTNAM r-NTY PROFILE
oe /29 /981
Mr T. COLIFORM
ABSENT
/ 100 ML
ABSENT
i
08/29/9£3
LEAD (IMS)
1.5
ppb
o -15 ppb
1
Oa /29 /Cre
NITRATE N I TROG7
1.83
MQ /L
08/29/9.8
NITRITE NiTRDG
<C).Q1
MG /L
N/A
9
08/29/98
IRON (Fe)
<0.060
MG /L
O -Q.8 mg /1
c
cis /2,7 /98
MANGANESE (MM)
':01.01 Q
ML f L
t y -i i . 8 mg / 1
2
08/29/98
StODIUM '(Na)
25.()
MG /L
N/A
081 /29./'919
pH
6.4
UN I TS
6.5- -A . 5
9
Irr,nDigGao,"rWrrni
:.t r-
LIm "l-
1 .1 "...
09/29/9G
ALKALINITY (AS
558.0
MG /L
N/A
08/29/48
TURBIDITY (TUR
:f
NTU
0 -5 NTU
COMMENTS:
FAX TO 2133 -792 -4776
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER (WAS) (WAS NOT) OF A
SAT I SF= AC'T'ORY SANITARY DUAL I TY ACCiORD I N THE NEW YORK STATE
AND EF`A FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
Pb /CLt LEAD 1 imi is for p
EPA Lead &: Copper
than 10% of their
than 15 ppb and a
treatment must be
pt-, ten tial.
ablic schools -ire set at 15 ppb.
Rule -Fclr Public Systems i equlres that no more
dist'ritution points have a LEAD v,ziGte of more
COPPER vaf,,.Le of, 1.3 met /L, else water
Undertaken tLn I -el-I. C9 t'hO w.tkt&T---. cn-rrOsive
Fe /Mn If both ircln and manganese are present, their total value
combined shall not exceed 0.5 mg /L.
i
091'04/1998 12:2iD 9142 153170 YORKTOWN MEDICAL LAB
YML ENVIRONMENTAL SERVICES
321 Kear• Strut
Yorktown Hoights, N.Y. 10593
( 914) F45 -EBOC,
Albert H, Pad- civanil Direct.�i:-
PAGE 02
1.
LAD #: 93.841209 CLIENT #; ;608 NON STMT P'ROC. PAG
N IV .Y M+v +�NNN1Y N -1---- N-Iw'I----- n1 ------------ - -I------------------ ----- - --- //' -
PROPERTIES EAST LLC MATE /TIME TAKEN: 08/28/98
20 COI -ONIAL DR DATE /TIME REC'L'. r,18 /29 /?e
DANF+URY, CT 06ell REPORT DATE: (p9/�!3/96
PHONE: (203 )-- ^92 -4776
SAMPLING SITE: LOT 10y, OUAF:ER MANOR SAMPLE TYPE..: PO'
SOUTH QUAf -.8R H I LI , PATTrERSON , NY PRESERVATIVES: NOI
COLD BY: THOMAS SCOTT TEMPERATURE..I
NOTES—., KITCHEN TAP COLIFGRM METH: `F
DATE FLAG PROCEDURE RESULT NORMAL - RANGE ME
Iota No limits for Sadiotr, are proscribed, Suggested quidelines state
that for people, on a sodiL:m restricted diet, the water sh,'Ltld
=Ontain no more than 2_; mg /L of Sc�diuen. Fclr 4"h7se �nr, a
moderately restricted diet„ a mA.� -JM m of 27(3 mg /L of Sodium
is sugge5td.
pH pH SCALE IN WA`;5'R F:AKIGES FROM 1 -i4. MEASUREMENT OF pH IS ONE OF
THE, IMPORTANT AND FREQUENTLY USED TESTS IN; WATER CHEMISTRY.
WATER WITH A LOW pH MISHT BE CORROSIVE TO METAL PIPES AND
FIXTURES, THE NORMAL RANQE OF pH 15 6.5 TO 2.5.
He 'TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
CONCENTRATION.. BOTH EXPkESSED AS CALCIUM CARFONATE„ IN MG./L,. THE
HARDNESS MAY RANGC FROM 0 TO HUNDREDS OF NO/L, DEFENDS ON THE
SOURCE; AND TREATMENT 10 WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0--71) MS /L VERY HARD WATER: ABOVE 3003 MG /L
MODERATSL t HARD WATER v 70-140 MG /L MG /L = MILLIGRAM PER L I TER
HARD WATER., 140 -300 MG /L (1 grain /gallon = 17.2 MG /L)
SUBMITTED BY;
A 1
Dir
tor.
FLAP#
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 10 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,
AJulius I. Cesare, P.E.
PUTNAM COUNTY DEPARTMENT OF HEALTH,
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address:
So . Quaker Hill
Town/Village:
Patterson
Tax Grid #
Map Block Lot(s) 10
Well Owner:
Name: Address:
Properties East LLC 20 Colonial Drive Danbury, Ct.
Use of Welt:
1- primary
2- secondary
x_ Residential Public Supply Air cond/heat pump .____Irrigation
Business Farm Test/monitoring Other(specify)
T 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 20 ft.
Length below grade 181 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
Yield 5 gpm
Depth Data
Measure from land surface - static (specify ft)
Overflow
During yield test(ft)
505
Depth of completed well in feet
505
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diamctcr(in)
Formation
Description
ft.
ft.
Land Surface
8
6
soil
8
505
6
Shale
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type Sub Capacity r,
Depth 4 6 0 Model 3 NFL 10 2– 5
Voltage 2 3 0 HP 1
Tank Type WX 2 5 0 Volume 4 4
Date Well Completed
4/1/98
Putnam County Certification No.
010 - -015
Date of Report
8/10/98
Well Driller (s' re)
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/olan.
Well Driller's Name Address:16 2 Baker Rd. Roxbury , Ct .
Signature: �c Date: 8,/ 10,/ 9 8
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
War 5+-3-T" 444V0 "C K19 - 1 -- 1-7
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by
Location - Street
Wc>,
Building Type
TownNillage
QC,4wce�- X!47? aA
Subdivision Name
/0
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 �_ Day 1 Z Year
General Contractor (Owner) - Signature
Corporation Name (if corporation)
Address: (] (�•c,,2
l
.,�
State ee, � � Zip 12S�C�
Signature:
Tit
Corporation Name (if corporation)
Address:_ cr-. �' ., ����. l %�'f
State Zip kG!�'z
Form GS -97
PEBLCOL&TION TEST DATA
2i— �MjT
� ► N(Y �r`QC) TT .�� %Ol�i DATE �r • 3 � �
iff Ynspactor 7 m 1.'v ' "►o's
I
Y• - '� �'�> ,the .undersigned', certUy that these porcolat ion Le:
ware done by-mynelf cr unda according to the atandar a. Tha
$data and results preaenta y�r`�• q c rect. PpFNEWrQp�
Dated: gnature c
W! icense No. (P.E
rwt
? _
�1
p*'OFESSIONP�
n��■r�r��a
I
Y• - '� �'�> ,the .undersigned', certUy that these porcolat ion Le:
ware done by-mynelf cr unda according to the atandar a. Tha
$data and results preaenta y�r`�• q c rect. PpFNEWrQp�
Dated: gnature c
W! icense No. (P.E
rwt
? _
�1
p*'OFESSIONP�
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Street Location Sg t Qv KKR Hat R,�e,_
Town
T`I
1. Sewage System 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. Sen•aere Svstei ';;
a. Septic tank snze`'= 1,000 ........ ,250 ........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. i`finimum 2 ft.Original soil between box & trenches
Junction Box - roperly set ........ ...............................
�Tngt required G 85 o Length installed _moo
2. Distance to watercourse measured-te,-1,00Ft..........
3. Installed according t ....................................
4. Slope en) accept i e16 - 1/32 /foot .............
5. 10 ft. b ptopdr line - 0 fE fo dations..........
6. Depth trench <3 i h s�frm e ..................
7. Roo o� oojel guns on, 100 % .........................
8. Size �e 3!4 - 1 %2" diameter clean ....................
a De th f 1' t h 12"
Date: yg
Inspected by: G; -
Owner W,55T Eh5r RGAL T Y
Permit# ?- 2- j - -q.7
Subdivision Lot # jo ''cpy, -( <er McAner
F grave in renc minimum ................... 5.
10. Pipe ends capped ........................ ...............................
gT. Size of pump chamber ... lido hon ............................
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. House/Building
a. House locatdd per approved plans ... ...............................
b. Number of bedrooms ....................... ...............................
IV. Well
a Well located as per approved plans . ...............................
b. Distance from STS area measured 4 ioo 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 & dinto exist watercourse
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ... ...............................
i. Erosion control provided ................. ...............................
Rev. 1/97
Form -
557-3
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PUTNAIVIrCOiTNTY DEPARTMENT
�j DIVISION OF ENVIRONMENTAL I1EA
�'Idi <y04 Kfr FIELDYACTIVITY REPO]
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Date Subdivision Approved k<- Fee Encloses
Type. "D R` • Lot Am 4 `2 FM Section (hey
Nuber of Bodroome Design Flow G P D r a PCHD Nofd!
swum" Sowww Sy aan to oaeafat alit GaD•a Sepdc Tank -ad
To be eructed by Addteaa
Water, supply. PamNc Supply Feom Address
on Y Pdvaft SopPb DrMW by ---- Addieas
ZIP
When Fm
M
Ofbee Reddreme b
1 roprosent that 1 am wholly and completely responsible for the design and location of the proposed systsm(s); 1) that the sapalole sevrage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu rons o • nom
County Department of Hanilth, 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
place in good operating condition any part of said saweg• 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 Compikoce of the orig'nal stem or any rapairs thereto; 2) that the drilled well described above
will M located as shown on the approved plan and that said well will Installed i enbr p w he standardfr rues and regu aT oii ns of the Putnam
County Deportment of Health.
oat . ' Sign .mat/— P.E.— R.A.
Address / License No r
APPROVED FOR CONSTRUCTION: Tnis approval axpir� two ! m the'date t ed unless construc on of the building has been undertaken and is
revocable for cause or may he amended or modified when Consider ry by th mmissioner of Health. Any change or alteration of construction
requires w per/n Approved for disposal of domestic scant and/ rivate water supply only.
Rev . tj IL
10/88 Oats al By �' TRM
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL�ly�
PCHD PERMIT #
WELL LOCATION
treet Addr ss
Town/Village/City
Tax Grid Number
WELL OWNER
Name
Mailing
Address
CrPrivate
O Public
USE OF WELL
primary
- secondary
ID-R-E-SIDENTIAL
D BUSINESS
0 INDUSTRIAL
0PUBLIC SUPPLY QAIR /COND /HEAT PUMP 0ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY D
AMOUNT OF USE
YIELD SOUGHT gpm /#
REPLACE EXISTING SUPPLY
EW SUPPLY NEW DWELLING
PEOPLE SERVED` /EST.
O TEST/ OBSERVATION
[3 DEEPEN EXISTING WELL
OF DAILY USAGE gal
D: ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
PbRILLED
DRIVEN
ODUG
OGRAVEL
O OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL-JS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
C-VA t ` :r- Lot No. D
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES A-' NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ----
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROV DED
O ON SEPARATE SHEET
(dat ) (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 drilling operations be contained on this
property and in such a manner as not to degrade or oth ontaAinate surface or groundwater.
Date of Issue:_ 19 14 q_
Date of Expiration 19- Pe it Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date �2 /1- 2, /9 9c�
Re: Property of e4.- �CCF L7z, ?7Las7�-� rcd):n S c.7-7-
Located at
(T) P.4�fi�cre.y Section / Block /. Lot /
Subdivision of /%1,.A-yoR /
Subdv. Lot # /p Filed Map # Date 7 (lo��j6
Gentlemen:
This, letter is to authorize !Z:,L =6cc0 4_l .CSAfi
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. , !,L // 74
Address
-67
W
Telephone
Very truly yours,
Signed
Owner of Property
2 cs
Address
�, i✓��ce ., Ce
Town
22>�r ?92 7TG
Telephone
PC -1
P U T N A M COUNTY D E P A 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:
2. Name of Project�(v /�.Mtc.- S� �e1' /o SSOS 3. Location T /V /C:
4. Project Engi neer: J M Iw f �� A,2� 5. Address: 4448 el ,
License Number: Phone:2i`I"7 /��
6. Type of Project:
k . 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? /
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 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? ..................
�8. If yes, name of water supply Distance to water supply
�9. Is project site near a public sewage collection or disposal system ?..... o
0. Name of sewage system Distance to sewage system
1. Date test holes observed )!A 110 22. Name of Health Inspector:
3. Project design flow (gallons per day) ...... ............................... . OCI-b °
11/9;
HYYr:NUTA M
P[TINAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROIZMarAL HEALTH SERVICES
AFFIDAVIT- CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH. DEPARTMWr
TO: Camnissioner of Health
In the matter of application for:
C 4a-
represent that I am an officer or employee of the corporation and am authorized
to act for
(Name
c
having of f ices at 2d O oa c�
Whose officers are:
Vice - President:
(Name and address)
Secretary:
(Name and address)
Treasurer:
(Name and address)
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.
'I
Signed:
Title:
Seal
20
K
F1
24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?..
�v
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, n/
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
any other potential known source of contamination. YES or NO
DESCRIBE:
2. Is there a local master plan or file with the Town or Village? ........... 4/4
3. Are community water, sewer facilities planned to be developed within 15 years? *4
4. Are any sewage disposal areas in excess of 15% slope? .......
5. Tax Map ID Number ........................ ...............................
6. Approved Plans are to be returned to: Applicant Engineer
r the application is signed by a person other than the applicant shown in Item 1, the
pplication must be accompanied by a Letter of Authorization. Failure to comply with this
ovision 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.
?GNATUP,ES & OFFICIAL TITLES:
V A)
'AILING ADDRESS:
Q.E"
•i�i..i •ii l .i 7 1.f'.. 1f: .'� :•:• :i
uivi ;� :%�t.
Wt T
' IVtS stD By Mr L P.G. H. D v I
Des;G.1 DNT.A S JNSE UL''O....IL SIS!i -M i J.c. NJ.
owne: I- OFT Cor p.1 lTohi4 FoR Address;
LO--Ud at (St=em) Zq. Q WA keR Hit_!_ Roo b Sc=. Block Lot
(indict e nearest- cross street)
4 M 1980
S ''.,� ��.` ` �FfSS1C3t��'
�_
1_ Tests to be re_a -atea at daoWi until aoorcy6mately *aqunl soil xate:�
are obt:ainc5 at each pe-rcolation tit hole_ All dat, tr I-Y- ti i�Yni l-tc
MAUDR �'UBDiV;S�ON
Wat x-she3 _
CA TON
4-am RcRcmmai =s�. am R. Bowm To Plz st3 m) w=H ikp2jao_nm
t>at` cf. F�-e- king ��aot% Si : Date of Pe= calzticn Test
. 7/;y1$y
BOL
P�tC7I�Cfi1 ,
R
Eizwz :.a: . :.,. : :. :: De?t, to — 'F_'ca :.
Yet--- Xevel
Igo.
T G�cunn St�� :'
In In C'*
Soil- .
5` Stcd
2�in. Strom StAo
Min/In brco
Inches, Ln es'.. Inc�es
$Mrjv ''' , ill..,,
2 li.oy -- l�J3Y
.:. 3oM/N o'er% $%�
3
10 c�Rr
lMrs
:AL.
S
2 '� %0� -11 :3� -
M.•>v a3%a a�l /�"'
r
: :�`
5 DRy ,
3:9-37 )l
9M7N " aY a9 /�
9
5��.
:
' 'S. t' oRr
o �
a
F
2.
044
3
4 M 1980
S ''.,� ��.` ` �FfSS1C3t��'
�_
1_ Tests to be re_a -atea at daoWi until aoorcy6mately *aqunl soil xate:�
are obt:ainc5 at each pe-rcolation tit hole_ All dat, tr I-Y- ti i�Yni l-tc
ible _ Area ` ?rovaded I > S r-
a.
THIS SPACE FOR USE BY HEALTH DEPAFt7MF.NT ONL
Soil Rats Approved sq- ft/gal -- Checked by
r 's
1880
Date
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DL'SC�tIPTION OF SOILS ENCOUNrERED
IN TEST HOLES
A `�
D&M HOLE NO. HOLE NO.
HOLE NO.
G.L.
2'
4
5 G cal
6'
L .
1U�
F
Oct
;13` '` Ob;e,,nxd �n �ne1d �1�( L.rn�h E kGk ;:r
4 ♦h.,etK `701';
wry x
-r
z..Ji`lJii�.,L•i. r�1YiYGL/ LSi n[I.i.� r 1.7
y S 7,• J
;
IbIDZCA� T�EVF:G ZV Ram WAM� R LEVEL RISFS Amt MING
DEEP W BYi
4. DESIGN
ible _ Area ` ?rovaded I > S r-
a.
THIS SPACE FOR USE BY HEALTH DEPAFt7MF.NT ONL
Soil Rats Approved sq- ft/gal -- Checked by
r 's
1880
Date
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
DOCUMENTS.
1_dklI
OTHER DATE �J_/ TAX MAP #
= PLCATION
PC -1
L PERMIT PWS LETTER
ENGINEERS AUTHORIZATION
DESIGN DATA SHEET(DDS)
= CORPORATE RESOLUTION
C= PLANS THREE SETS
= HOUSE PLANS - TWO SETS
= VARIANCE REQUEST
SUBDIVISION
EffLEGAL SUBDMSION
DIVISION AP ROVAL CHECKED
11! PERC RATE 2.0 ®-
= FILL REQUIRED EPTH
=CURTAIN DRAIN.] Q D =STANDPIPES
GENERAL
Y
= EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
= IF PUMPED PIT & D BOX SHOWN & DETAILED
= HOUSE - NO. OF BEDROOMS
= WELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM
m PROPERTY METES & BOUNDS
= HOUSE SETBACK NECESSARY (TIGHT LOT)
= HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE
= NO BENDS; MAX. BENDS 45° W /CLEANOUT
FILL SYSTEMS
C= CLAYBARRIER
= 10 FT HORIZONTAL: SLOPE 3:1 TO GRADE
= FILL SPECS = FILL NOTES
= FILL CERTIFICATION NOTE
= DEPTH GAUGES
= FILL PROFILE & DIMENSIONS
= VOLUME
= FILL IN EXPANSION AREA
EX- APPROVAL SSDS ADJ. LOTS
= WETLAND ( TOWN/DEC PERMIT REQ ?)
TRENCH
= DATA ON DDS PLANS & PERMIT SAME
= LF TRENCH PROVIDED =60 FT MAX
= PRE- 1969 - NEIGHBOR NOTIFIFICATION
= PARALLEL TO CONTOURS
= LETTER BI/ZBA
= 100% EXPANSION PROVIDED
m 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 f TOP OF FILL
T
=
SSDS HYDRAULIC PROFILE = GRAVITY FLOW
20' TO FOUNDATION WALLS 15' WELL TO P.L
= CONSTRUCTION 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)
= TWO -FOOT CONTOURS EXISTING & PROPOSED
= 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
= DRIVEWAY & SLOPES CUT
= 10' TO WATERLINE (PITS -20')
= FOOTING /GUTTER/CURTAIN DRAINS
= 50' INTERMITTENT DRAINAGE COURSE
= EROSION CONTROL; HOUSE,WELL, SSDS
= 200 FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS
= EROSION CONTROL NOTE
= 15'MINTO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35'- 1°/x,100' <1%
= PERC & DEEP HOLES LOCATED
= 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS.
= REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK
= LOCATION MAP =10'. FROM FOUNDATION; 50' TO WELL
COMMENTS:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date Ap2/L
Re: Property of ew*
T'r !cc- LTA �7Lus �Z 76-'r� SC-TT
Located at �('o -� Qu,4er -K 9i /I /4•
(T) ®so,y Section /a Block /. Lot 2 S"
Subdivision of ,�c,AaZ!Sr' A4goA
Subdv. Lot # / O Filed Map #
Gentlemen:
Date
This letter is to authorize !j-j w4 u c 1. ( :E.S f r
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 14$ or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersign
P.E. , R.A. , �612 2(,
Address
Telephone
Very truly yours,
Signed
Owner of Property
Address
P �3 ce IV--e
Town
12--s 71 It 1 6776/
Telephone
SSDS DESIGN REPORT
QUAKER MANOR SUBDIVISION
LOT # 10
QUAKER MANOR SD LOT # 10
4 Bedroom Design
Design Flow: 4(200 gal /bed) = 800 Gallons
Perc Rate: 31 -45
Application Rate: 0.50
Req. Area: 800/0.5 = 1600 sq. ft.
Req. Field Length: 1600/2 = 800 Actual 816'
Septic Tank: 1250 gallons
Dosing Required
Dosing Volume: (pi)(2/12)2(800)(.75)(7.5) = 399 gal
Dosing Chamber: SC 6 X 6 380 E = 28"
RLI: 623
Use 12 lines, 68' long each System and Expansion
Variable Fill 0.5' - 1.5' Required
FIA).' 10— "34 1 1
— TE!
D 240 P
May 10, 1994
Julius Cesare, P.E.
Black-berry Hill
Brewster, New York 10509
New York City Re: Quaker Manor SSTSs
Department of
Environmontal (T) Patterson, Putnam County
Protection
Dear Mr. Cesare:
Ourgau of Water The Department has inspected, the deep holes, 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"he ten SSDSs for lots I - 10 meet the requirements
of 10 NYCRR Appendix 75-A. The ten 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 QUallty Control
(914) 742.2080 Sincerely,
465 Columbus Ave.
Suite 350
Valhalla, New York 10595-
1336
Ja :s :W. Roberts, P.E.
Program Engineer
Commissioner
xd: Town of Patterson Planning Board
Putnam County Department of Health
RICHARD O. GAINER, P.C.
Deputy CommisslOnef
Julius I. Cesare, P.E.
Blackberry Hill
Brewster, New York 10509
914- 279 -7115
May 1.5, 19.96
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,
P
Julius I. Cesare, P.E.
page 2
eirrrINU l_A 1R
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENT!AL HEALTH SERVICES
AFFIDAVIT- CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PU1'NAM COUNTY HEALTH DEPART
TO: Cam- aissioner of - Health
In the matter of application for:
Aq
I, `�•� JCe77-
represent that I am an officer or employee of the 96rpo4ation and am authorized
�r _:o� %! �. _- -�� -`�'- =ate ,i ��_�i����'i•
having offices at 20 C•O /o,VIA -c
C-31N
Whose officers are:
President:
(Name and 4L ess)
Vice - President:
(Name and address)
Secretary:
(Name and \address )
Treasurer:
(Name and addre -s s}-
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
Sign
Title:
Corporate Seal
20
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