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HomeMy WebLinkAbout0267DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -41 BOX 3 L . �! T so IT IN 961 f L '` ' 00076 I PUTNAM COUNTY DEPARTMENT OF HEALTH RdV,. 3186 I V Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF COMPLIANCE CONSTRUCTION PERMIT FOR S AGE DISPOSAL SYSTEM S (� 0 Permit # _? i C�oN Town °i�` , Located at� - l: Subdivision Name Subd. Lot # Tax Map---l—Block Z Lot gi A 1 Yi s 7. Renewal_ ❑ Revlslon ❑ Owner/Applicant Name i C..l.. Date of Previous Approval Mailing Address 3 ( ?,C- H Town PAT' 1E R:5n N zip i Z f , 3 Building Type- . CSI IDEAIC - Lot Area Z 4, 4 A c. Fill Section OnIY Depth 3 r volume_ — Number of Bedrooms Design Flow G /P/D J Z CIA I PCHD Notification is Required When FIB ie completed Separate Sewerage System to consist of L S 0 23 Ganda Septic Tank and 4-0 ® L n F T K i " ci ALL it P-1 To be constructed by • ' j o R F - 7J TS Q M i !� A Address Water Supply: Public Supply From Address or: x Private Supply Drilled by 1: .3 ; D 1 _Address Other Requirements I 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 describe will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will Place in good operating condition any part of said sewage 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 Compliance o" original system or any reps' t ereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be stall in accordance w�the an rds, rules and egu a� ont' s of the Putnam County Department of Health. Date 7 ._ 1 + _ is Signs P.E, R.A. - v Address 1 > Z License No % J APPROVED FOR CONSTRUCTION: This approval expir from a to issuetl unless construction of the building has been undertaken and is revocable for c use r may be amended or modified when aces y y the C missio r of Health'. Any change or alteration of construction requires av,� per�itr�,Approved for disposal of tlome sew o, a or pri ate iaa r supply only. ,t Date -81 I t/l'1Jb/V1if By Title PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 FOR SEWAGE DISPOSAL SYSTEM Located at t`°' r` G k Subdivision Name '' Subd. Lot # Owner /Applicant Name � `'�a A'a Malling Address �l 1rC l � A6 // R o C/ Clr Engineer to Provide Permit # on CERTIFICATE OF COMPLIANCE Permit # 14e Ir'S fj Town T. Map —Block Lot Renewal_ ❑ Revision ❑ Date of Previous •Approval Town 'Re J'S-n 11 Zip ! -,I 6 -:6 Building Type i a�114- Lot Area k56140' FBl Section Only Depth Volume Number of Bedrooms Design Flow G P D %®Z040 PCHD Notification Is Required When Fill is completed Separate Sewerage System to consist -o�f� 00 on Septic Tank and 4.1 711' F 774—na r` To be constructed by AA=:J =e Address Water SuPPIY: Pu''bllc ,Supply From _ Address or: Private Supply Drilled byddrese Other Requirements 1 represent that 1 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 standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of HealtSwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder. that said builder Will place in good operating condition any part of said sewage 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 Compliance of the original 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 ac rdanc with r f, rules and r u au icons of the Putnam Coun y.Dep rtment of Health. Date �, "3 _ �. Signs P,E.R.A. J y Atltlress • S:P�.in License No uTJ APPROVED FOR CONSTRUCTION: This approval expires fh=fl. om the d e issued unless construction of the building has been undertaken and is revocable for cause or ma be amended or modified when c cessar Commissioner of Health. Any change or aIteration of construction requires a new p rmit, �A�r�ved for disposal of tlomest r�itar ewa e n4 priva�e waterSupply only. -� j io-_*' !l r ',. " C is S ".• J 1 ': i a PUTNAM COUNTY DEPARTMENT OF HEALTH'5 En eer to Provide Permit N r � Rev. 3186 Division of Environmental Health Services. Carmel N.Y:10512 � on CERtWiCAIM OF COMPLIANCE' \\ STRNCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit .fl, ted at 1 I T„ own or VNage fSubdivislon Name Subd. Lot N T. Map Bloch Z Lot n ` Renewal_ 0 Revision Owner /Applicant Name Y� Date of Previous Approval —n Z1 � Mailing Address �i'' " V ��• Town "��Tw _ Zip Z� Building Type 1< -1:��t 4t Area Z ` FIB Section Only Depth. Volume Number of Bedrooms Design Flow G /P /D Z– ©� PCHD Notification is Repaired When Fill Is completed Separate Sewerage System to consist of Gallon, Septic Tank and `^'e!� To be constructed by _—'rs �' Address Water'Supplyf_ PabllcSupplyFront Address or:_ --,– ate Supply Drilled by Address Other Requirements represen 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 standards, rules and regulations of e Pu ham County Department of. Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of .Healthwill be submitted to the Department, and a written ,guarantee will be furnished the owner, his. successors, heirs or' assigns by. the builder, that said builder:will place in good operating condition any part of said sewage disposal system. during-the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the. original 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 w' beiastalied accordance with 'the a dards,. rules - and regu a ;� owl' ns -of the Putnam County Department of Health. tt q �j Dater (. •�.. .Signed e�Cd�- t'�C7�c.- -':(/� _ P -E. ��R.A. Address _ • `��`-"^a License No �7v 1 APPROVED FOR CONSTRUCTION: This approval,expires 4s ; rfrom the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessprp,..by the Commissioner of Health: Any change or alteration of construction requires a ew permit. Approved for disposal of domestic sanitar . sewage, and /or ete r su ply only. ate By ki APPENDIX C . FINAL SITE INSPECTION Date 5' Z `/ "(�- i Inspected b • LOCATION OWNER C, TM # OR SUBDIVISION LOT # YF- �• �a II. IV. OJT . CCMME�}I'g SEWAGE DISPOSAL AREA A.. SDS area located a5 a prOVed' lanS . b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG . DPTH c. Natural soil not stri oed c - d." Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. SETiAGE DISPOSAL SYSTEM I�O 0 a. Septic tank size - 1, b. Septic tank installed level c. 10' minimum from foundation d. No 90° bends, cleanout within 10 ft. of 45° bend e e. DISTRIBUTION BOX 1. All outlets at same elevation -,vat-e- test j�.� 2. Protected below frost 3. Minimum 2 ft. original soil be n bo d trenches YY f. JUNCTION BOX - properly set e g. TRED1= 1. Le-rigth required - Length installed / D-N) . 2. Distance to watercodrse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from property line - 20 feet - foundations av ev e-c- 7. Depth of trench < 30 inches fran surface 8. Room allowed for expansion, 50% .9. Size of gravel 3/4 - 11" diameter 10. Depth of gravel in trench 12" minimum s' 11. Pive ends capped h. PIMP CR DOSE SYSTEAIS 1. Size of pum chaIIlC w' t/ 2. Cverflcw tank 3. visual /audit I v Pixno easily accessi nie manhole to cr_de 5. First box baffled o. Cycle witnessed by Health Department estimated flcw per cycle �. ` =C' --e 1ccaten per ant: =vex plans. a �. __ of tedrec s =L,=-::- e! 1 1CC=ted =S plans ( 2 b. Distcance fran SLS __ - .- .=sure -d c. Casina 18" above =ce d. Surf: ce drairaae = -und well accept =b_=. CVO ALL WORKMASHI? a. Boxes properiV arc—azed , b. All pipes part-i - = = "s : = i fled c. A11 pipes flush wi try inside of box d. Backfill material ccntains stones < 4" in diameter v �. e. Curtain drain ins tailed according to plan f. Curtain drain outfall protected & dir.to ex i st. watercourse g. Footing drains discharge away fran SDS area- h. Surface water rotection adeouate 1 r. YYI�l.; -- MI1 �"'Yl'1 TY/'1�111'. [^� -- CT --- i•rs...- -... �L.... l CQ_ . . .. _ /i i YEft . �tnT T l�l1l1ATT TT7/lAT ni+nnnm ly .e T C ,• 0¢ Wr.LL VVL-u i,ui-LvLv DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET AD RESS: 1VWNJV1tLAC11CIf7 TAX GRIO NUMBEri'. / . ��So NAME: ADDRESS: Pi ` ❑ PUBLICS J WELL LOCATION WELL OWNER USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. 1N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ff REPLACE EXISTING SUPPLY ❑ DEEPEN., EXISTING WELL DEPTH DATA ° WELL DEPTH 411510 _.ft. STATIC WATER LEVEL f 4? ft. I DATE MEASURED j DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE t / ' ❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH A2 I tL MATERIALS: 9STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE L9 f ft JOINTS: ❑ WELDED If THREADED ❑ OTHER DETAILS DIAMETER 7 in. SEAL: ❑ CEMENT GROUT 98ENTONITE ❑ OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE 16YES ❑ NO LINER: OYES eNO SCREEN DIAMETER (in) �LO7 SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST 0 YES ONO SECOND HOURS GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE:. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOht DEPT}{ It. WELL YIELD TEST If detailed pumping M HOO: O PUMPED 1 tests were done is in- Off COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- in9 well Dia- meter FORMATION DESCRIPTION Cool_ ft. It WELL DEPTH It. DURATION hr, min. ORAWOOWN It, YIELD gpm. Surface /3 G r Ai- WATEfi CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER runnFt -- CAPACITY DEPTH VOLTAGE HP WELL DRILLER N DATE ALBERTM. HYATT &SONS, INC. ADDRESS Well Drilling SIGiAT1JRE Rte. 311 R. R. 2 Box 171A ,�t�.� �/ oaTTr0Q0N NFW YORK 12563 if�/i� ' ---_----_-_-___-_--_--__ vp �r-- ___ ___ ___----'-------'---- ' ----_--__--'__-_. ___ pie - �0— ----------- --- - ------ PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - NAME ( 1 v 1 C.& ADDRESS 1 ` o. MAILING ADDRESS TELEPHONE et Municipality (T)(V 0. Box I Post Office Zip Code PERSON IN CHARGE OR INTERVIEWED S; 6 1 1 T Name and Title DATE —'2/ TYPE FACILITY U Sheet of INSPECTION Orig. Routine Orig. Complain Orig. Request Compliance Complaint Comp Final _ Group Illness Construction Reinspection Field, Sampling Only Field Conference Other TIME ARRIVED._. TIME LEFT Explain FINDINGS: INSPECTOR: `KV . Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report .................. TITLE: TELEPHONE: DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM loFILE NO. <--- Owner S Prjc- �Address � f / Q10 ac� Located at (Street) 3-�_ 1 rCA /'�/ Sec. _— Block ? Lot (� ,�)(,�indicate nearest cross street) Municipality _,� t 7 h9w7na) Watershed f-V 4-C II SOLI, PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking 7`- go Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run ,Elapse Depth to, Water From Water Level No. iTime Ground Surface In Inches Soil Rate Start -Stop 'Min. Start Stop Drop In Min/In Drop Inches Inches Inches �V)eh 2 J:3� - f � 6, 4 Oe*2, 5 1 V. 39 9-V-7 4 5 1 2 3 4 5 .7 -Z57 I f 1 / N=: 1• Tests to be repeated at same depth until approximately equal soil rates are cbtained.at each percolation test hole. All data to-be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 1+ TEST PIT DATA RDQUI1M TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1' - 2' 3' 4' 5' 6' 7' 8' i 9' 10' 119 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: - - DESIGN - Soil Rate Used )_1-30 Min /1" Drop: S.D. Usable Area Provided 5 t, z lJ.. No. of Bedrocros 45 Septic Tank Capacity /S 019 gals. Type Absorption Area Provided By L.F. ° ' 4441---W4 elth -ti- aeh Other ` . f 1' " 1 C��-o /�Pr S' s _rte Bile.. e,. '+k , • • - �A tip_- �,�� ;1,, THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ® �Y'°®" ®® FESSION Soil Rate Approved* sq.ft /gal. Checked by Date LAURENT ENGINEERING ASSOCIATES, P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 914.278.6108 RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR.. PE. CONSULTING SITE ENGINEERS July 13, 1987 Putnam County Health Department 110 Old Route 6 Center Carmel NY 10512 Att: Mr. William Hedges Re: James Price Birch Hill Road Patterson, NY Dear Bill: Enclosed are the following: 1. Three (3) prints of Drawing SS -1S "Proposed SSDS- Revised July 13, 1987; 2. "Construction Permit for Sewage Disposal System ", dated July 13, 1987; 3. "Design Data Sheet" for Fill Section. We would appreciate your review, approval and re- issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERI G ASSOCIATES, P.C. <�T> Randolph W. aurent P.E. /map CC: Mr. James Price with one copy each DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services June 23, 1986 Mr. Randolph Laurent 73 Fairfield Drive Patterson, new York 12563 Re: Proposed SSDS Price Birch Hill Road (P) TM 7 -2 -18 Dear Mr. Laurent: JOHN SIMMONS. M.D. Deputy Commissioner Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: 1) ..Deep test-pit #1 notes ledge at 5 feet. The use of tri- galleries .would require 3 feet of R.O.B. fill. ./2) Review of the house.plan raises concern to the number of bedrooms in the proposed dwelling. ✓3} Will distribution boxes or junction boxes be used? If junction boxes are to be used, details are to be provided on plans. . Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM/jp You ry truly, Robert Morris Environmental Health Technician I TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 I RANDOLPH W. LAURENT, P E., P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12583 914- 278-8108 CONSULTING SITE ENGINEER To: Putnam County Dept. of Health Two County Center Carmel NY 10512 Attention: Mr Robert Morris Gentlemen: We enclose (4 ) copies of: Date:July 11, .1986 Job No.: 8602 . Proposed SSDS Birch Hill Road Patterson, NY (X B/W Prints ❑ Reproducibles ❑ Reports ❑ Tracings ❑ Specifications ❑ Memorandum ❑ Copy of Letter II Permit Description: Revision /Date No. Three (3)copies of 03S -1F "Preliminary Design For Fill Placement OnlyI(Fi11 Plan) datf- 7- 11_ -86 One (1) copy of SS -1S "Preliminary Design for Fill Placement Only" (SSDS Plan) dated 7 -11 -86 Construction Permit (Fill Section Only) dated 7 -11 -86 Sent Via: • Our Messenger ❑ Blueprinter 0Tirst Class Mail ❑ Special Delivery • Your Messenger ❑ Hand Delivery ❑ Copy to: Very truly yours, RANDOLPH W. LAURENT, P.E.,P.C: Per: Richard S. Clark /• •• • DI V114 1 0 zo • Y. • •' • •• •' 1� Y '1 �• Mn•. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address Located at (Street) Lit RCN A i L-L- � O a ►� Sec. -_ Block Z_ Lot i �3 (indicate nearest cross street) Municipality his, -z-r a Watershed C SOIL PERCOLATION TEST DATA RDOMM TO BE SUBMLITIM WITH APPLICATIONS Date of Pre- Soaking 5 i/1- 6(o Date of Percolation Test 5 HOLE - NUMBER C1,O(:R TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 U5 -1 o Z/A Z3 2 i Z o to - 1: t 8 -12- Z A z-t 3" zA 3 1 i y - z: zi -1.z Zt.{ 4 5 3 1001 - 2'oi (oo ZA 2Z 3,• Za 4 5 Drr 2" 4�'_m_ 1 IN 2 TINA BOUNTY 3 DEP) . OF h is ft : :F, i— 4 5. .. _Tests to': be repeated ;pare `6 twined at each for review. 2. 'Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be sukrdtted be made from top of hole. 2 tz • oo 1 :oo (00 3 1001 - 2'oi (oo ZA 2Z 3,• Za 4 5 Drr 2" 4�'_m_ 1 IN 2 TINA BOUNTY 3 DEP) . OF h is ft : :F, i— 4 5. .. _Tests to': be repeated ;pare `6 twined at each for review. 2. 'Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be sukrdtted be made from top of hole. TEST PIT DATA REQUIRED TO BE DEPTH HOLE NO. I HOLE NO. HOLE NO. G. L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED p CIE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 1.1 a M E DEEP HOLE OBSERVATIONS MADE BY; [nor r is !fp- L Act f-rpef DATE: 5 _ DESIGN Soil Rate Used zi_ 3O Min /1" Drop: S.D. Usable Area Provided `IO O © sjr No. of Bedrooms ..Septic Tank Capacity, S 00 gals. Type Absorption Area, Provided' By AOp L.F. m 24u --w4_ h 4 m% Other Name R�c�,.1oaL..P i 1 vJ LA �2G ni'i- Signatur Address `73 r A� RF 1 ELb �Rt V E SEAL ! 6 W 'R s. tT —_ o tit _ NEW yo cZK �1 N�` a� 0 <v O N A KI e� THIS SPACE FOR USE BY HEALTH DEPARD[ENT ONLY.D ,FEa510� Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date .J cJ ,.1 S '9 c' Re: Property of �jp�M�s�► Located at (T Section '( Block Z- Lot \6 Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineeror 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 o g icI.%;Ir 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. SS6 pO + A1AM r Q.,1. Very truly yours,, F°j�. OF fjEA T.1 Signed %Ama.=WA'I� L--'Owner of Property Countersigned: James D. Price P. E. , , # 7: 3 Fat i r.9e Ij io rt1J!f Address Pot 9yo , VU. �, �49's6� 90 9" -(1O<P Telephone RR4 35 - Birch Hill Road Address Patterson, New York 12563 Town 914/878 -3698 212/289 -4513 Telephone RANDOLPH W. LAURENT, P. E., P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 914 - 278-6108 CONSULTING SITE ENGINEER Date: June 5, 1986 To: Job No.: 8602 Putnam County Health Department Project: Two County Center Proposed SSDS Carmel, NY 10512 Birch Hill Rd., Patterson, NY Attention: Mr. Robert Morris Gentlemen: We enclose ( 3) copies of: ` (R B/W Prints ❑ Reproducibles ❑ Reports ❑ Tracings ❑ Specifications ❑ Memorandum ❑ Copy of Letter Description: Proposed SSDS - Sent Via: ❑ Our Messenger ❑ Your Messenger 2 copies of Architectural DwQs Health Dept. Permit ❑ Blueprinter ❑ First Class Mail Eb Hand Delivery Copy to: Mr. John Horton (2 cc Prop. SSDS & cc Health Dept. Permit) u Revision /Date No. 6 -S -Sh s ❑ Special Delivery Very truly yours. RANDOLPH W. LAURENT, P.E.,P.C. Per. ,, Randolph W. Laurent, P.E. P[TI'NA 4 COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONNMNTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS f REVIEW SHEET - OONSMUCTTIION PERMIT DATE�s� BY (Street Location) DOCUMENMS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization- Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two, -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;'shown;gravity flow,suff. size If- Pupped Pit & D Box Shawn & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 110; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan). 15' to Drains -Cli in,Stonn,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked .Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same (Name of Owner) DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #LdL�LI WELL LOCATION Street Address Q- Town/Village/City Tax Grid Number WELL OWNER Name . . MMe's Mailing Address Ld.. t0 C6 :5 oj aitrivate 0Public USE OF WELL 1 - primary 2 - secondary ❑ RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL Oj?UBLIC SUPPLY ❑ AIR /COND /HEAT PUMP IffFARM O TEST /OBSERVATION E31NSTITUTIONAL ❑ STAND -BY ❑ ABANDONED E•OTHER (specify AMOUNT OF USE YIELD SOUGHT PEOPLE SERVED /EST. OF DAILY USAGE ,6() gal REASON FOR DRILLING CINEW SUPPLY PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 1- t - WELL TYPE DRILLED DRIVEN E]DUG ®GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES _11!!� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ALBERT- M I-IVATT R SONS, INC- Lot No.' Well Drilling WATER WELL CONTRACTOR: Name Rte. 311 R.R. 2 Box 171A Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES J/ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION Q0 ON S PARATE EET (date) (signaturlp 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. c Date of Issue: AAA., 19 LA ermit Issuing fficia Date of Expiration: .%L3 "�e. /& 19 9 White copy: H.D. File Permit is Non - Transferrable Yellow copy: Building Inspector Pink Copy: Owner 2/87 ,,__ -_- - ---- T., -,, ,, -- / i WELL O i 1 I I I I I I I I / 4' C.I. i (1 0 / loll 30X (.1 `iF WELL RRI ME couNry PL ? NAM S 15 -26 -30E 57.84 N 78 - 1.7 20 W 18. 85 30W 01 09 -30W S 62 -p2 i S 16 - - 30 E 116- 5OW S 13 - 103. 34 S23 - 10 -OOW 51 20W S09 - 20 - 1 31 • 41 \? k0' E 147. 52 ` -44-10W 40.01 S13-3f 40 140.18 \ W3 y0 134- O, SOB. OW 59. 12 , /a h O s r0ne w °j1 io M v h J h N n y )ck ) PIP )d ?i 0 3 m 29-/OE uti /ity Area = 24.4135" ac res N 24__- --- 30 E F7. pole / �a a `/ V barn garage / 1d ' yJ °/5 383.92 z.5 - sty wood fi, dwell. st Darn aorc y o�ep W C O I N N iz 2 0 O W) N l696.1/ I� h O N t0 N 335' i O n restricted area N N_ \ � O N67- 44 -40L25 ' 121.36 633.91' `�\ N2/- 44 -50E 2514 i400d r line