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Home My WebLink About0258DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -22 BOX 3 00067 �� 9 -� , 1 4 16 :I�`.. J � T 1� ;' 'III I . 00067 Other Requirements . �I certify that•the,system(s) as listed serving the above,premises were conatru ted essentially as', shown. on 'pla -�of the.completed work ( copies of which are attached), and in.accordance with the standards, rules'and ragCaoni ;Putnam County Departmeennt�Of Health. Oats ■� "� Certified by. Address Any person occupying premises served by the above witemisj shall promptly take such conditions ►eiulfiriy fiortii such "usage: "Approval `of the separate-sewerage systim shall available and the approval of ,the private water suppb shall become null and void when subject to modif,icattio-n/or' change when, In the judgment. of, the Commission Data Co, / / ' By in accordance with th 'led an,' d•the permit issued by the • P.E.[ R.A. License No. ✓ a ion as may be, necessary to secure the correction of any unsanitary become null and void as soon as a p%AW: sanitary sewer becomes a public water supply becomes available. r Such approvals are h vocation, modification or change is necessity, Tit Is XPi�_G4 � . ' '� WELL uunrUily" RDrvc%i a. .10, OF HEALTH 1 Division Of Environmental Health Services �� PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION SfREE1 AOURESS: TDWHIVILLAG11CHY TAI GRID NUUABER: �;ele ��.� d h S- WELL OWNER NAME: ADDRESS:. &r�_, �,`�r. P61VATE O PUBLIC USE OF WELL 47- primary 2- secondary -ti-RESIDENTIAL O PUBLIC SUPPLY 0 AIR /COND. /HEA PUMP O ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) p INDUSTRIAL O INSTITUTIONAL d STAND -BY O MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING WREPLACE EXISTING SUPPLY [TEST /OBSERVATION [] ADDITIONAL SUPPLY NEW SUPPLY (NEEW,,��D''WELLING) []DEEPEN EXISTING WELD. DEPTH DATA WELL DEPTH � It. STATIC WATER LEVEL a it. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY VCOMPRESSED AIR PERCUSSION t7 DUG ❑ WELL POINT ❑ CABLE PERCUSSION 0 OTHER (specify): WELL TYPE Cl SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK Cl OTHER CASING DETAILS TOTAL LENGTH _. fL MATERIALS: STEEL O PLASTIC C1 OTHER LENGTH BELOW GRADE tL JOINTS: d WELDED &THREADED 0 OTHER DIAMETER 7_, in. SEAL: I9CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 101t. DRIVE SHOE: WYES U NO L1NEA: YES ONO SCREEN DIAMETER (in) 'SLOT SIZE UNGTH (It) DEPTH TO SCREEN (it) DEVELOPED? DETAILS FIRST DYES ONO SECONO _ HOURS GRAVEL PACK d NOS GRAVEL DIAMETER SIZE: OF PACK M. TOP DEPTH tL eorroM DEPTH It. WELL YIELD TEST II detailed pumping METHOD: O PUMPED 1 tests were done Is in- O COMPRESSED AIR , formation attached? • BAILED O OTHER 0 YES d NO E�L LOG it more detailed Iormation descriptions or sieve analyses are available, please attach. EFTN fRaM SURFACE r w,1e, geif. ing welt 0ia• meter In FOAMATIONDESCRIPTION coot t. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Sur,3ce (, d' / " . C D v WATEn CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑YES ONO STORAGE TANK! 'TYPE CAPACITY GAt. PUMP INFORMATION TYPE MAKER MODEL CAPACITY - DEPTH VOLTAGE HP WONYATT & SONS, INC. oAtE ft. AooRESS Well Drilling SIGNATURE j PATTERSON KNEW YORK 12563 ft &ti J" loll .. q�SF�uE NORTH AMERICAN M �lc� /I -� 7-,5- CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 96 -5879 CLIENT: Robert Johnson PO Box 573 Patterson NY 12563 -0573 SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: DATE RECEIVED: DATE OF REPORT: Kitchen tap: 5 Bridle Ridge, Patterson NY R. Johnson Jr. 08/29/96 TIME COLLECTED: 2:30 PM 08/29/96 09/03/96 ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent Must be "Absent' SM18(9223) 08/29/96 E. Coli Absent Must be "Absent" SM18(9223) 08/29/96 This sample, as subn -tWed to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ✓ ACCEPTABLE. _ NOT ACCEPTABLE. M r� Maryann Fasano, Assistant Laboratory Director NYS ELAP #11218 CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914- 278 -7600 / Fax 914 - 278 -7754 / E -mail: NoAmLabs ®aol.com PCJINPI•i CO;JM DAP -'PP 7T OF BFAMjH DiVISI r ENV%RO',IME_ _L kFA -LTH SERVICES g,PT : e — `S- / Z-7 Omer or Purchaser of Building Section B ocK Lot � kg_____�Wz �� Building Constructed by Location - Street Subdivision 'torte l�inicic l ity Subdivision Lot Building Typ-_ GUPRP�Vi"r.F OF DISFOakr, SYSTEM I represent that 1 am wholly and comipletely responsible for Lhe- location, wor;�ranship, material, construction and drainage of the sewage disposal system serving the above described property, a-Dd. that it has -been constructed as s.hoYn on the approved plan or aporov.ed amendment. thereto;.. and,. in accordance with the standards, rules and regulations of the -Putna'm County Departir -ent of Health,.' and ,hereby gua- r-antea to the craner, his successors, heirs or assigns r - .to place in go6d operating condition any part of said system constructed by me which fails to operate for a period of two years iBnediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal systeni or any repairs Riede by -e- to such systean, except where the failure to operate. properly is caused by the willful or negligent act of .the eccuapant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the dete.aniration of the Director of the Division of Environ.rental Health Services of the Putnai-u County Department o- Health as to whether or not the failure of the system to operate was cause by the willful or nealigent act of the occupant of the b —1 zng utilizing the system. Dated this dy day of �. 19 'T(, C-e-neral Corit- raCtor (0'nie*") - Signatt re Corporation Name Corp.) PZdress rev_ 9/85 M�_, Siena Lure ` v Title Corporation '-mma (if rp. ) 1 I PUTKAM COUM DIP 07BRALM ohmen litu d Bum SW46& CaMbA Mr. Ip ' 40 Air MfatRl�atf'4 i rwesent1hat I am wholly, and completely reMonsiblo for above described will be constructed as shown on'the ipprpv4 County Department of H,sjljh. and that on completion te be submitted to the.. Ow . artntent, and a written qua rants plilis in go" operating 'condikili4i any part 'of, said � " ones of the apparel of the Cortiflj:aIo. of Construction sells be located as sa a an the approved plan and that mid i County Deportaitent•of.Health. A' L A design and location of. the ?#09od Sygt*"S); 1) that .the ospe►ate disposal fyftem opt th4isi"to and in,iMiMnce with the standards, rules gnu regulalsonspi Ing )f a --cortificito of construct , ion c6nipliancir sitlifamitory to this Commissioner of Hwkhwill ill 60 turns shod the owner, his successor u 11 1. . ►_ . _I � % heirs or assigns by the builder. that mid b Oder will glsposal :Sydolia during the period f t Immediately following the da.to of. the lnu- of the original syster thereto;2) that the drilled well 6*900" 16o"s or :ni, W., will be Instal fill in acco n Ith rules and rog—UMWn—s*f the Putnam rigned E.4 RA. —License No APPROVED FOR CONSTRUCTION . :this . approval expires . I two years ff0in'the datVissued unloss'o 'I struction of the I building has been undertaken % and is revocable for cause or. may, be.amend . ed,or,modified when considered necessary by. the Comm[ or alteration of construction "Quires lKit. Azov4d for disposal Of. Ic sanitary sewage. and/or WV. Dab BY itN — J.1188 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #— ✓ �__ �� WELL LOCATION Street Address Village City I Tax Grid Number WELL OWNER Name MCI fling fi. C pp, Addregsl K 1670) d 00rivate O Public USE OF WELL _- primary 2- secondary SIDENTIAL ❑ PUBLIC SUPPLY Q AIR /CON /HEAT PUMP BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL 0 INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# ❑ REPLACE EXISTING SUPPLY VfNEW SUPPLY NEW DWELLING PEOPLE SERVED!j_;5_/EST. OF DAILY USAGE , Sal O TEST/ OBSERVATION GI ADDITIONAL SUPPLY L1 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING '. -- WELL TYPE DRILLED 13DRIVEN E]DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES t! NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: GHQ L t No: WATER WELL CONTRACTOR: Name T j . Address - IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V-' NO NAME OF PUBLIC WATER SUPPLY: 4., /Gr TOWN /VIL /CITY P& T' DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED , ON SEPARATE SHEET (date) 06rgnature ) 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 suc manner not to de r otherwise contaminate ndw&t.-er•. Date of Issue: 19 'sY- Date of Expiration 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 I(U /\ -7v Second Floor BEDROOM 3 ---� r X1111 M Date First Floor .1 ' 16' BEDROOM 2j I 10' -O' 4.01 27'8 ". i I STANDARD NEWFOUNDLAND FEATURES • Luxurious First Floor Master Suite • Fireplace Options Available • Compartmentalized First Floor Bath with • Consult an Authorized Westchester Builder Two Separate Vanities for a Complete List of Options • Formal Entry Foyer • ArJst's renderings and Floor ?Ian Dimensions are • Formal Dining Room approxim -ate. Wspeci5cations oust t-- Wrinen in ttr_ Conuacc No oral conditions. • Formal Living Room • Spacious Eat -in Kitchen V ESTCHESTER ODULAR OMES, INC. v. Reagan's Mill Road • Wingdale, NY 12594 (914) 832 -9400 • (800) 832 -3888 RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. September 5, 1996 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Lot 5 Bridle Ridge Rd. Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing S -5, "As -Built Plan", dated 8- 29 -96. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 9 -4 -96. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 9 -4 -96. 4. Well Completion and Well Log Report, dated 5- 14 -96. 5. Water Analysis Report, dated 9 =3 -96. 6. Money order in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. cc_ hc4to Harry W. Nichols, Jr., P.E. HWN:DJ:bd 95099 enc. cc: Mr. R. Johnson LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. FN CONSULTING SITE ENGINEERS December 1, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Bridle Ridge Estates Lot #5 Bridle Ridge Road Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -5 "Proposed SSDS -Lot #5 ", dated 11- 30 -95. 2. "Application For Approval of Plans For A Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 11- 30 -95. 4. "Application to Construct a Water Well ", dated 11- 30 -95. 5. "Letter of Authorization ", dated 11- 30 -95. 6. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 7. Money order in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, , LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:bd 95099 enc. cc: Mr. R. Johnson Jr. w /enc. ' 7P ICJ T NA., M, C O iJ XV- T `5t � � p,p,. RT M l✓ ITT T O >E' H E,,A. r. T>E� APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1 . Name and Address of Applicant: TOE N�DN "T� 1�2 . T -r- f 'f`� �� •Y 126402 2. Name of Project: i��'IIPDGJ�t� ��ps 3.._. Location C�/V /C:�TI'll�i i 4. Project Engineer: 5. Address: 01JA0 ODD GNP# License Number: Phone: �L�1 _ blol3 6. T e of Project: : '- •• I: •.. _.. Private /Residential Food.Service ....Commercial Apartments Institutional Mobile Home Park Office Building. :3 Rea_1ty Subdivision Other (specify) 7. Is this project subject•to State Env ronmerital-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 acceptabl-e by.Lead Agency? ......:.... rJ /� 10 Rame of Lead Agency ti. Is this project in an area under the control of-local planning, zoning, or other officials, ordinances? ....... K)b' 2. If so, have plans been submitted to such: author. sties ?..................... 3. Has preliminary approval beers'granted by such authorities? NSA Date Granted: 4. Type of Sewage Disposal, System Discharge...... • .Surface water v Ground Waters 5. If surface water discharge, what is the 'stream class designation ?........ O //A 5. Waters index number (surface) .... .... ............. .... ........... T. Is project located near a public water supply system? .................. IQ 3. If yes, name of water supply Distance to�water supply , �. Is project site near a public sewage collection or disposal system ?..... KJO �• Name of sewage system k1 /A Distance to sewage system . Date observed: 23. Name of Health Inspector: Project design flow (gallons per day) ..................... j2o0 �2. 25.' Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ 00 26. Has SPDES Application been submitted to local DEC Office? ............... _ ►J� /A 27. Is any portion of this project located within a designated Town or State wetland?..... ............................... ............................... 28. Wetland ID Number. ........... ............................... /d 29. •Is Wetland Permit -required? * ............................................. Has application been made to Town or Local DEC Office? 0 30. Does project-require a DEC Stream Disturbance Permit? .................... tJ D 31. Is or was project site used for agricultural activity involving application of pesticide$_ to orchards or other crops, solid or hazardous waste disposal; - landfilling, sludge application or industrial activity? ........ YES or NO ►J0 32. Is project located-within 1;000-feet of existence of abandoned landfill, hazardous waste site, salt stockp:i,le,.landfill, sludge disposal site or - any other potential known•source -Of contamination? ..............YES or NO K)d DESCRIBE: - 33. is there a local master plan or file with the Town or Village? ............ 34. Are community water, sewer facilities planned to be d6veloped within 15 years? UNKNMOn1 35. Are any sewage disposal areas in excess of' 15% slope? ......................7 1 0 36. Tax Hap ID.. Number ......................................................... Gam._ . 22 37. Approved Plans are- tobe; returned to: ................ . App-1icant. Y"" _ 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 maybe 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 Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. , SIGNATURES OFFICIAL TITLES: �� o0 �ZZ f✓1 f Rio � � NAILING ADDRESS: Oj�- �J�Tt2 , N ` 1050 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Da te % -1 - 5 • Pro . %AMA - ,'I Located at (T) 9�/��4�1 Section lr�_ Block Lot Subdivision of Subdv. Lot # Filed Map # Date �l O Gentlemen: This letter is to authorizery 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.:p.: Counterdign P.E. Address Telephone r F NEWECH 1 il Very truly yours, Signe< N Y. ` I0,95-50 Address Town 4rD - Telephone z w ,o EX /5 S DEN�'E AI O L �. ✓.clsoR3S� 8 4 9 5 6:0"o.C. (TYR ) _ S. 60=ztf- v> w. i o�n o� 9R/ ®LE RID6E ROAD lOt70 GAL � ' seP rANk i /3 5 . TR:ENCf/ 12 14 �� t5 R O l6 m�w o v 160-00'. 9R/ ®LE RID6E ROAD .4S- BG/ /LT v1m,F1YS 1ON CHART (1NFT) N° A B l 04.0 43.0 2 34.0 54. O 3 41.0 59.0 4 48.5 64.0 5 56.0 7/.0 6 69.5 76.0 7 47-5 96.0 8 53.0 /00.0 9 59.0 / 04.0' 10 66.0 106.5 / 1 73.0 / / 2. 0 /Z 70.0 33.5 1.3 73.5 40.5 14 77 5 46.5 15 60.5 53.0 16 66.0 60.5