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HomeMy WebLinkAbout0307DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -3 BOX 4 IL 61 Jr L T IL Tbd 00116 tr c� x '« r, ; . r.s h ,.,xs�- '^'7,.°w+,, °.,^.vc °aF•- ter^. -R-c �-°, - r^^�r-- -w �' - •, +fiYn�fi�tu�"k`r�T`�'`.�'�c �u': _,� �- x,"`+s Gila, t`'.�,3:d�%"'� --�� It P ITNAM COUNTY,DEPARTMENT OF HEALTH . a ` ev 3186 Dtvtston of Environmental Health Servtaes, Carmel, N Y.10512 i En eer 1VFast Provide y t<' P C:H D Permit p CERTIFICATE OF CONSTRUCTION;,COMPLIANCE FOR SEWAGE DISPOSALSYSTEM S Town or Yf at r �/• Ta: Map f 3 ,. Block Lot �. Own r% pltcant Name S a edy Satidiviston Name '� ' u = // Sabdv.' Lot p . ... -.4 -., - dareae N P Date Permtt Issues L7 Separate Sewerage System -ballt by Address Conalethg of ' I: LJ 0 GaDon:Septtc Tank end FO Y• PP Y �m Water Sp • 1 bu Private' Sapply I)rWed on Q Badlding Type -�d i� Has Eroeton Contiol -Been mpletedY S Ntimber of Bedrooms Has Garbsge.Grindei' Been inetelledY Other Regalrements �. •Ti2r f�''J �/ ��' ,i certify that;thesystem(s) as listed serving the ,above- premise 's were wnetructed`easentidlly ae'shown the: plans of the completed wozk`(cbpies of which; are,attaghed),'and in accordance ` with the itandW4r ,' rules and r` lit16no; in accorc�aoc` " "wi ' filed plan' and: the 'permit ,issued''by the Putnam County De rt % w nt f Health P:Er�Y-```__ t t2.A: , Address i S leans No." / `f { Any parson occupying promises served by' fns above system(sf shall promptly take such actbn`aa,may be'rropadry to toc, ' ho correction of any unun)tary conditions resulting from such usage Approval of tho separate sswsvage system shall bewms null and void'as: own as a pubt": ionitary "sewor becomes availablevnd the-'app'roval-Lof the.:private; water suppiy.,shall become null and voi0 when a er`wpply bo�omei:avalgbN. Such - approvals are 'subject cation' or change when, `,in the` judgment of the Commissioner of, H th, :fur svocM modiflcation or Change is necessary, :;Date�i�C.t� G/ TItN�d , RANDOLPH W. LAURENT; P.E HARRY W. NICHOLS JR., P.E. December 5, 1996 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance O'Dell Subdivision - Lot #7 Town of Patterson, New York Dear Bill: Enclosed are the following: xa ON LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing S -7 "As -Built Plan ", dated 11- 11 -96. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 11- 11 -96. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System", dated 1 -1 -96. 4, Well Completion and Well Log Report, dated 11- 30 -95. 5. Water Analysis Report, dated 11- 14 -96. r,n CD 6:'-- Money order in the amount of $200.00 payable to Putnam County Health Department. these are any questions concerning the enclosed, please call. " Yery-truly yours, `";! -:LAMENT ENGINEERING ASSOCIATES, P.C. w Harry W. Nichols, Jr., P.E. HWN:TR:bd 95061 cc: E. Pescatore w /enc. utp wrbli kvr1rLG11V1V ME.rVRl DEPARTMENT OF HEAt.TH bivisioh Of Environmental H6aith Services PUTNAM COUNTY bEPARTMENT or HtALTH ^� Office Use Only v Fs- WELL LOCATION 11110 AOURESS: [Owfily1tcluticily TAX GRID NUAttlp: rat � — 2 WELL OWNER NAME: ADDRESS: Fes Q p PRIVATE O PUBLIC USE OF WELL 1 - primary 2- secondary (71 RESIDENTIAL O PUBLIC SUPPLY IJ AIRICOND. /HEAT PUMP O A ANDONED C] BUSINESS d FARM d TEST /OBSERVATION 0 OTHER (specify) C1 INDUSTRIAL O INSTITUTIONAL d STAND -BY d I111OUNT OF USE YIELD SOUGHT ��Z� gpm. /ND. PEOPLE SERVED / EST. OF DAILY USAGE i5? gal. REASON POR DRILLING CJREPLACE EXISTING SUPPLY []TEST /011SERVATION [JADDITIONAL SUPPLY W)EW SUPPLY (NEW DWELLING) [)DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH It. I STATIC WATER LEVEL it. I DATE MEASURED DRILLING EQUIPMENT Cl ROTARY YCOMPRESSED AIR PERCUSSION O DUG O WELL POINT d CABLE PERCUSSION d OTHER (specify): WELL TYPE d SCREENED d OPEN ENO CASING e-OPEN HOLE IN BEDROCK .O OTHER CASING DETAILS TOTAL LENGTH,_ _ ft MATERIALS: MTEEL O P4ASTIC O OTHER LENGTH BELOW GRADE _ _ ft. JOINTS: d WELDED O THREADED . ❑ OTHER DIAMETER :_ In. SEAL: CEMENT GROUT d BENTONITE I]OTHER WEIGHT PER FOOT Ib./I1. DRIVE SHOE YES d NO I LINER: DYES wft SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH To SCREEN (ft) DEVELOPED? DETAILS FIRST O YES (i NO SECOND _ HOURS GRAVEL PACK " YES C] NO GRAVEL SIZE: DIAMETER TOP OF PACX fd. DEPTH K. BOTTOM DEPTH h. WELL YIELD TEST I If detailed um in M HOD: O PUMPED I tests were done is in- 1 COMPRESSED AIR , formation attached? Cl BAILED O OTHER 1 O YES ONO ,WELL If more detailed lormitian descriptions or slave analyses OG ate available, please attach. DEPTH FROM SURFACE. Whir gEAr. In9 Well Dis -. Ineler PoAMAnok OESCAIPTION coot It It WELL DEPTH It. DURATION hr. min. DRAVIDO'NN It. YIELD 9rm. Sunrtu! ° CS Q Y d clouDr NAItDNESS ti COLoPEO ANALYZED? d YES ONO ANALYSIS ATTACHED? B YES d00 rMAXFn CLEAR TEMP. 5TORAGL TA1 X t tt#g r CAPACITY v. CAk• 11PORMATION �u 9 CAPACITY 4 DEPTH -- __Q :Z VOLTAGE�GHP WELL DRILLER NAME OAJE /� ALBERT M. HYATT & SONS, INC. ADDRESS Well Dri lling SIGIIATURE Rte. 311 R.R. 2 Box 171A 1 "RSON, NEW YORK 12563 3189 -- - - - U 3'iiT y CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 96 -7712 CLIENT: Albert Hyatt & Sons RR 2, Box 171A Patterson NY 12563 SAMPLING LOCATION: Outside spigot: Ed Pescatore, 7 Caroline Dr, Patterson NY COLLECTED BY: M. Hyatt DATE COLLECTED: 11/12/96 TIME COLLECTED: 1:05 PM DATE RECEIVED: 11/12/96 DATE OF REPORT: 11/14/96 ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent Must be "Absent" SM18(9223) 11/12/96 E. Coli Absent Must be "Absent" SM18(9223) 11/12/96 This sample; as submitted - to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ACCEPTABLE. _ NOT ACCEPTABLE. 4 all n ` -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 PUTNAM COUNTY DEPARIMENr OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PC5 COZ6 r .Owner or Purchaser of Building Building Constructed by Location - Street r �tJL. e e-s y-4 Municipality Building Type !3 a 3 Section Block -Lot Ga�,5�L, Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the.sewage disposal system serving the above described property, and that it 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 follcaing the date of approval of the "Certificate of Construction Compliance" for the sewage disposal 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 Director of the Division of Environiiental Health Services 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 this day of 4friV 19 �Ie General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature1�.yy, ++ Title �92N Corporation Name (if Corp.) Address Tn1 R S 649412 i a Z IM Ate, Fm Seeffm Ody' Depth Z V Volans ZfYS Nao•bw d Bedroom 4� Design Flow G P D TOO PCHD Notmcmdm Is Regdmd When M V am*W d Sepgnls Sewomp Symen to callow d-1290 GVlon SepfJc Took eniL_f �� L' �• •��iic = %r Cr�C �, GEf To be.celashuded by 7�t3•r� Address Water Sappb: Pdit Sappy Fnn ' Addraa an ph iaw, Sq,,* Dried by - _ Add m War Reaa6emeua AS' If Z 1 repro nt'.that 1 am wholly and completely responsible for the design and location of the proposed system(s). 1) that the separate seway di al s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ns o • 114"1 County Department of Health, and that on compWion thereof a. "Cafificate of Construction Compliance" satisfactory to the Commissioner of Mealthwill be submitted to the ppartnisnt, and a written guarantee will be furnished .the.owner, his succeerors, heirs or assigns by the butow. that said builder will Dim in good operating condition any part of Said away disposal system during the period of two (2) years immediately following the date of the eau- once of the approval of the Certificate of Construction Compliance of the iginal system or any repairs then i 2j t t the illed well described above wM M located as shown on the approwd plan and that aid well will be instal in_.aecordenp with stan:4 wits cad r u ns of the Putnam County Departnam of N•Nth. G r q c O.E R.A. Date Sign Address ,^'t+ r{jg rar✓rzc - License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construdro� of the ikling .MS been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of stealth. Any change or alteration of construction requires a w permit. Approved f r disposal of domestic sanitary �seyrage- epd/o water supply only. REV. 10/88 Oate -a 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 #_L__I�!_`� WELL LOCATION Street Address Ca O ' o Village City Tax v Grid Number WELL OWNER Name Mail ' ng Address Y Zr" JRPrivate 0 Public USE OF WELL ® - primary 2- secondary J19 RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑PUBLIC SUPPLY O FARM U INSTITUTIONAL QAIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY 0ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION L1 ADDITIONAL SUPPLY JONEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING c WELL TYPE DRILLED DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES __X_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. `7 WATER WELL CONTRACTOR: Name ZM> Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: N& TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED f� 7S P ON SEPARATE SHEET J_ c (date) ignature) - -_ 7 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 otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19 - -L-f— Permit Issuing 0 icia __ Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller :G>XC7'13CJ,,TAt-�C CO CJ�] TY 1�EP A. 'z MENT O F HE.A.L.T APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAG.SYSTEM 1. Name and Address of Applicant: • �-�e� �y Coy /z 2. Name of Project: P/_0/00s ed Locationo/V /C: 4.. Project Engineer: /Tao""- 1 �,% ��r -�G,� 5. Address: Millbrooke Office Centre Brewster, NY. 1x509 License Number: 4657 $2 Phone: (914) 278 -6103 6. Type of Pro.iect: :., Private %Residential Food.Ser.vice Commercial , Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7:. Is this project subject'to State Environmental - Quality Review (SEAR)? 0 Type Status (Check One) Type I.. Exempt Type II. Unlisted. X_ 8. Is a Draft Environmental -Impact, Statement, (DEIS) required? NO 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of Lead Agency W 11.. Is this project in an area under. the control Of -local planning, zoning, or other officials, ordinances? ......... ............................... /old 12.-If so, have plans been .submitted to such : author .sties....................... /II 5 13. %Has preliminary approval; been granted by such authorities? IV14 Date Granted:, I4.:Type of Sewage Disposal:'System Discharge...... -Surface Water X Ground Waters 15. If surface water discharge, what is the stream class designation? ........ i '6. Water_$ index number (surface) ...................r........... ......... N� '�. Is project located near a public water supply system? .................. No °. If yes', nave or water supply �� //� Distance to water supply --" 9. Is project site near a public sewage collection or disposal system ?..... A/b '0. Name of sewage system /�A Distance to sewage system 1. Date observed: 23. Name of Health Inspector: { �00 ~• Project design flow (gallons per day) ............:........ .............. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. No 26. Has SPDES Application been submitted to local DEC Office? ............... N 27. Is any portion of this project located within a designated Town or State wetland ? .................... Alp 28. Wetland ID Number. ............... ............................... IY1114 29.. 'Is Wetland Permit, required?.............................................. No Has application been made to Town or Local DEC Office? ..................; 30. Does project require a DEC Stream. Disturbance Permit? ...................tea Wi. -n 31. Is or was. .project site used for agricultural activity involving application of pesticide$ to orchards4or other crops, solid or hazardous waste dispose , r landfilling, sludge application or industrial activity? ........ YES or Nn -- r� 32. Is project located within 1;000�feet of existence of abandoned landfill, co Zn hazardous waste site, salt stockpile, landfill, sludge disposal site or any other °potential known•source of contamination? ..............YES or NO* A/v DESCRIBE:. 33. Is there a local master plan or file -with the Town or Village? ..... Ale, 34. Are community water, sewer facilities planned to be developed within 15 years? Ukk -aw,7 35. Are any' sewage disposal areas in excess of 15ro slope? A70 36. Tax�Map ID N. umber ......................... ............................... /3 — 3 37. Approved Plans are to'"be= returned to: Applicant - Engineer If the application is signed by a person other than the applicant shown in Ite .p•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 be lief. Fa Ise stateM,ents -made herein are punishab7e as a Class A Hisder,reanor pursuant to Section 210.45 of the Penal Law. 11 % J .4 A SIGNATURES & OFFICIAL TITLES: Millbrookh Office Centre 'AILING ADDRESS: Brewster, NY 10509 .d 17r ° T PUMM CCUNTY DEPARTMENT OF HEALTH = DIVISION OF HEALTH SERVICES DESIGN DATA S=- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. owner �d i✓GY�. Address y ,L�x Y/?" CG��,� NY �osrZ Located at (Street) Ca e- Z)r l ✓ � Sec. 13 Block �; 2 Lot (indicate nearest cross street) Municipality /-G Yll6kgdA7 Watershed �rd�pvj SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - .soaking Date of Percolation Test � 3 HOLE NUKBER CLOCK TIME PERCOtMCN PE ROOLATICN Run Elapses Depth to Water Fran Water Level No. Tire Ground Surface In Indies Soil Rate ' _ Start-Stop Min. '_ Start Stop Drop In Min /In Drop Inches Inches Inches 21 S0 e 3�'. ► �o - _Q Lo 3.0 30 4 5 33; 3' -7 4 5 1 2 3 4 5 :iN=: 1. Tests to be repeated: at same depth until apprcmimately equal soil rates are obtained at each percolation test hole. All data to' be,suhmitUd. for review.... :• . 2. Depth measurenients:to be made fran top of hole. TEST PIT DATA *REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUN MED IN TEST .HOLES ` DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO. G.L. sc� i� •' " Oo 450 L ' s . 2' ILT Y ::SA VD 3' 61cT 64WO 4' 5' -77 oc YY yu 71 �� 8' ' 10' . 11' 12' 13' 14' rr INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Nt�- DEEP HOLE OBSERVATIONS MADE BY: RWVy 0��W S J✓ ..� _ DATE: le-7 DESIGN - Soil Rate Used 21-3a Min /1" Drop: S.D. Usable Area Provided- No. of Bedroms Septic Tank Capacity JZSa gals. Type ✓ � Absorption Area Provided By ( L.F. x 24" width trench Other Name Signature OF N 0� // SEAL 5 Address �%i ���r �CP. �)� cam , v�r� 47 .. * Q x LU ` THIS SPACE FOR USE BY HEALTH DEPAPMVM ONLY: F 0. .. OAP�. Soil Rate Approved sq.ft /gal. Cbecked AOFE�`O� by Date a Tee PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONIMENTAL HEALTH SERVICES Date Re: Property of ��wgro� /�G.S6a �vk-e_ Located at ca✓O�!1r� (T) Section r Block Z Lot 3 Subdivision of a Subdv. Lo ;1 Filed slap Date Gentlemen: This let ter is to .authorize /iL_14O /S ..a duly licensed professional engineer X or registered architect (Ind4cate) to- apply for a Construction Permit for a separate -sewage system, to serve the above noted property in accordance with the standards., rules or regulati.ons..as promulagated by the Commissioner of the Putnam County Department of Heal tin', and to' sign. all .ndcessary 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 Lai-.r, and the Putnam County Sani- tary Code. �i ounce i3ned: P.E. , R.A. , Millbrooke Office Centre Address Very truly yours, , Signed �. Oi.°ner of Property or A,�<�� Address O Sv"n Brewster, ,NY 10509 Telephone 914 - 278 -6108 Telephone: p�ivlEiVsIoN Nb- A G Z 7/ 4lO s 3 75 625 4 Bo -6,66 5 84 64 s �O Boo 5 70 7 97!' 75-5 B 92 B/ 5 . 9 95 s B9 /O 99 5 9G 5 /Z 57 55 /3 6Z b0. j4 (09 P7 73.5 74 /!o . V 5 8O /•T. B5 B5' s /9 B9 5 9 s Zd 97 �/ s Zi .9.9 5 G(o ZZ %O Z 70 23 105 s 745 ZQ 10,56 7& 5 25 1,04 s fo Zlo 10.5 93 Z 7 /Ol0 5 BB ZB lag 5 9-3 V e V\