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Home My WebLink About0311DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -7 BOX 4 . . !y% .. �T 0 F.m f �` .. J�6 .- 00120 \\� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES TIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCH ONSTRUCTION PERMIT # P, ,;z -7 Located at 6tcahL,.P_ Dry 4'i c Town or Village Owner /Applicant Name// [/M 440 d lII S Tax Map / Block Lot Formerly Mailing Address / e,'o 4 Ihq Subdivision Name ODe %l Subd. Lot # Zip O� Date Construction Permit Issued by PCHD /d .. a-q7 U U Separate Sewerage System built by ��_/ Address AL J��t Consisting of / Gallon Septic Tank d � �� 5 7 d-o "e , Other Requirements: Water Sunoly: Public Supply From Address or: D� Private Supply Drilled by Gu 'Ades Building Type ASS -;dajixp Has erosion control been completed? im S Number of Bedrooms Has garbage grinder been installed? 0/00 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 prgyaed plans and the standards, rules and regulatio of the Putnam County Department of Health.�- Date: Certified by P.E. ( g►► Profe ional Address ,/ /Aft 0 �' ' f r License # Any person occupying premises served by the above system(s) shall raptly take such action as may becay 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 revocatio , odification or change is -necessary. /° // Ad 4G ate: ' By: Title: l� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 / 1�1 WELL GUMYLETLUE4 Kr1rUK1 * * DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TOWNIViEUCIE10Y TAX GRID NUMBER-. Carplln -D (Z -Lo% 3 ?0 Person WELL OWNER NAME: e Y I m A I i 15iz ADDRESS: S f9 PBIVATE ❑ PUBLIC 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. /N0. PEOPLE SERVED S / EST. OF DAILY USAGE 500 gal. REASON FOR. DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY NEW SUPPLY (NEW DWELLING) Q DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH LszO ft. STATIC WATER LEVEL _�. ft. DATE MEASURED I " ZS - R �? DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specifyj: WELL TYPE ❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH fL MATERIALS: STEEL ❑ PLASTIC O OTHER LENGTH BELOW GRADE a O n, JOINTS: ❑ WELDED 0 THREADED ❑ OTHER DIAMETER Ca in. SEAL: W CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT _13_ Ib. /ft. I DRIVE SHOE. J0 YES ❑ NO I LINER: G YESANO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TU SCREEN (ft) DEVELOPED? FIRST o YES ONO HOURS SECOND GRAVEL PACK O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH K. WELL YIELD TEST If detailed pumping P P METHOD: ❑ PUMPED 1 tests were done is in- • COMPRESSED AIR ; ' ormation attached? • BAILED O OTHER ; ❑ YES ❑ NO 'WELL LOG It more detailed formation descriptions or Sieve analyses are available, please attach. DEPTH FROM suRFACE 6 a�rr ina Well Oia- (meter FORMATION DESCRIPTION coot ft. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Surface O V2.7- bU rclen ca05 _ i,v i rnE e, 05 8 5 fan. e WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAT, . PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME I d AR'j -S i an w eL LL co _74- Ic DAB _ - ADDRESS (� jJ 5 !2 T' S a SIGNATURE C ARmF_L N 10,S is 3/69 0 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance O'Dell Subdivision Caroline Drive (T) Patterson, NY Dear Robert: Enclosed are the following: 1.. LAURENT ENGINEERING ASSOCIATES, P.C. / MILLBROOKE OFFICE CENTRE \ Route 22 8 Milltown Road 3. Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS March 17, 1998 Well Completion Report, dated 2/16/98. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance O'Dell Subdivision Caroline Drive (T) Patterson, NY Dear Robert: Enclosed are the following: 1.. Five (5) prints of Drawing S -3 "As -Built Plan ", dated 3/17/98. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 3/17/98. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 3/13/98. 4. Well Completion Report, dated 2/16/98. 5. Laboratory Report, dated 3/13/98. co ~ cn r 6.* Application Fee in the amount of $200.00 payable to Putnam County Health Department. a+ P u If there are any questions concerning the enclosed, please call. crt Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. t Harry W. Nichols, Jr., P.E. HWN:T�Ybd/ 97035 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM _KC-VIA) -f 0- 9,PB7/, 3&- j3. c 7 Owner or Purchaser of Building Tax Map Block Lot ,vim. . Building Constructed by 6gKQ,L 1n3 Z 71121 y ,E- Location - Street Building Type Town/Village Subdivision Name 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 _3 Year / ?c2-�- Signature:we� tractor (Owner) - Signature Corporation Name (if corporation) Address: ,ep-7 93 State J7�� tiY Zip zs-6— Title:. � 14 kle 6� -/ sa,� Corporation Name (if corporation) Address: ��j� iI%a ,r,;�•,�� State ,tJP,J /�%' %fvrcG. c,/- Zip Form GS -97 Y V U IU.LUl N0R2!HRAST ]LABORATORY OF DANBURY 39 -3 MrLL PLAIN ROAD' • DANBURY, CT 06811 (2031 748 -7903 - FAX (203) 74$ -0652 LABORATORY REPORT -- WATER SUPPLY TESTXNG i I !I ' II CT Cert: H -0404 N1 Cer 11471 REPORT PTO: BOYD WELL DRIL.L..ING DATE SAMPLE COLLECTED: 3/11/98 ROUTE 52 TIME COLLECTED: 12:00 P.M. CARMEL; N.Y. 10512 COLLECTED BY:: H. BOYD DATE RECEWED @ LAB: 3/11/98 TESTED BY LA.13#11471 REPORT DATE _ 3/13/98 SAMPLE SITE: SHERWOOD HOMES, MCALLIISTEf4 CAROLINE DR,, PATTERSON, N.Y. SAMPLING POINT: OUTSIDE FAUCET SOURCEi WELL Tt2EAT NT: NONE TEST PERFORMED, RESULT: MAXIMIUM CONTAMINANT LEVEL BACTERIAL: Total oliform (Bacteria) 0 per 100 ml 0 per 100 till PHYSICALS! , ! pH 7.41 no designated; limit Turbidity 0.78 NTUs 5 NTUs CHEMISTRY: Nitrite ;N <0.01 tng/L as N 1 mg/L as N Nitrate;N 1.42 ntg/L as N 10 mg/L as N' Alkalinity 144.0 zng/L no designated: limits Hardnoss 183.0 tng/L no designated: limits ! Iran 0.035 mg/L 0.30 mg/L . Manganese <0.01 tttg/L 0.311 mg/L [Note: Combined Limit for Iron plus: Manganese = b.50 mg/L] Sodium 25.5 mg/L, 20 mg/L** Lead <0.005 mg/L 0,015*** ml = Tnillilit�r ing/L = milligrams per Liter ND = none detected NTU =Units I . "Notification Level *"Action Level i RESULTS BASED ON SAMPLES SUBMITTED:3 /11/98 SANIPL , AS TESTED ABOVE: �X OTABLE, or NOT POTABLE (PER NEW Y %K STATE 06PT, OF; HEALTH SERVICES STANDARDS FOR POTABLE WATFA) f .Laboratory Director "r k *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860) 8:28 -9787 - FA3; "(S60)8Z9 -1.050 TOLL FREE WITHIN CT: 300 - 826- 0105.OUTSIDE CT: 800 -654 -1230 ...-.. �,- ..,:,�`.,- T n i •, inns. iurr in rru-i i r -u-v i i •, ins. i ir,. i i . ` _ . � :-,. � �. r ,-.-, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 9- Inspected by: G1 QED Street Location C-19ROLIAIE -DRjV,_r_ Owner Xe Town P,4T'-rr_p,66W Permit# -a7- TM# J-3,—p-7 Subdivision Lot # y'�E� . 4. Sewaze Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth_ c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands ..................................... II. Sewaee Svstem ' a. Septic tank size ( L,000 ......... 1,250 ......... other ................ b. Septic tank install�kevel ............................................... c. 10' minimum from foundation ......................................... d. Distribtuion Box 1. All outlets at same elevation-water tested ................. 2. Protected below frost ................................................. 3,. Minimum 2 ft.Original soil between, box & trenches Junction Box - properly set ...................................................... I . Lengtgrequired ':3 on Length installed 3 .9e? 2. Distance to watercourse measured,-F'Lclo Ft.......... 3. Installed according to plan ........ ........... ; ...... 4. Slope of trench accep able 1/16 - t.* 7" 5. 10 ft. from p pe ine - 20 ft, ions 6. Depth of trenc < inches fro surface . ............... 7. R in lowed r ex anion, 10 % ......................... 8. Sze of ravel - I Y2-" lameter cle ... .. ... 9. epth o g,,) v I trench 12" mini .. .. .. 10. ipe e s ze e .............................. .. g. ac'ep able i3 ...... 0-0t../ p i e ine f da ions� < c e, c inches arface . ..... d r ex ansi to 2 trench 'e' tren & "e .............. PujPsed Svstems Do 1. Size of pump ch e ....... ........... ........... ... ,le . m r 2 OverfloKtalik arnl/,'V ik 3 Al is I/au io .............. .... .... .... ... . 4 Pump e, a . si le, ma lie t grade ................ 0 4... , 5. First box ed ....... .. ........... .... ............................. 6. Cycle wi5nessed by ti ated flow/cycle ........... 111. House/Build1ing a. House located per approved plans .................................. b. Number of bedrooms ...................................................... IV. Well a. Well located as per approved plans ................................ b. Distance from STS area measured _�_ 167 0 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 ............... Qk h. Surface water protection adequate ................................... 01 A i. Erosion control provided ................................................ L? /4 Rev. 1/97 YES NO COMMENTS L/ i2_ 4-reeti �eE �4 L/ L P 17 ez Z/_ 6 j AIr P, mp r V Ajo �' P. 1Ze_;Z Pipe- ny+ af ecid V P-) S '14- re tie e Form Sn- 1c, PUTNAM COUNTY DEPARTMENT OF HEALTH ' Dlldeler dBovRwsaoW Helm Saevtbm Carsel. N.Y 16511 Xnatim r to P►ovWe Peastt 1 all CERTdi11CATE. OF CONSTRUCTION PWGT FOR SEWAGE DISPOSAL SYSTEM Pee>olt / •� .� cs�� L►1J � i l y � own. as SD �2 V011tge sidwmals Nome Sid. Lot i Tax Map 1 J ; OwaedAppilaatNaeeiL�VI N �l{cl�t,- �5��1� Rattertl_o itevhto0 0 Date of Previous Approval MAMS Ad&vu Town 23. patg Subdivision ADRro ed Fee Enclosed ®' Amniint Mddkg Type Q�S 15E K T I iii_ Lot Ares, 2 i - Fm s-rd- only Depth volume Nsaber d Bedmoun 3 Dedgl Flow G P D 0 PCHD NotlB sdan to Requhmd When FBI to ool„pkad Separate Selsouge Systems to eo=W of 000 Galba Sepdc Twill and To be coed taad by `gam Addma Water Suppb': PdWe Supply Film Addreee supply DOW by T� 7 Aadnem Other Reoahemenq 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s)i 1) that the separate .sewage dispoul a stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu Wns o e Ram County Department of H"Ith, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will IM submitted to the Department,, and a written guarantee will be furnished the owner, his successor; heirs or assigns by the buckle►, that said builder will place In good operating. condition any part of said sewage disposal system during the period of ff mediately following thedate of the I=- once of the approval of tM Certificate of Construction Compliance of M original system or an2) that the drilled well described above will be located as shown on the approved plan and that said Z will le In a ed in rda with les and rpu�Tai%ns �thtnarn County Department of MMlth. Oab S(, P.E. Address. 1 i Va v i f i Licemse No APPROVED FOR CONSTRUCTION: This approval expires two years am t e date issued less construction of/the building .has been undertaken and is revocable for cause or may be amended or modified when considered j by the Co oner of Mae" . Any change or alteration of construction requires a now. mit.% Appr ed for disposal of domestic sanitar and /or pr' ater supply on j�- Rev . �� 'Z / (C IO/HH ate _�._ BY Title APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS VIEIW SHEET for CONSTRUCTION PE ?4IT� STREET LOCATION .Q`�� g� !' NAME OF OWNER `Xf 6 BY. B. HEDGES R.MORRIS OTHER DATE 10 �ITAX MAP # Z -— DOCUMENTS. M YI ITT Y ��RMTT APP CATION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE w PC -1 fi- c '�� IF PUMPED PIT & D BOX SHOWN &DETAILED m WELLPERMTT ED PWS LETTER HO M ENGINEERS AUTHORIZATION wl M DESIGN DATA SHEET(DDS) PRA M CORPORATE RESOLUTION HO IIZ ED PLANS THREE SETS HO 1:11 HOUSE PLANS - TWO SETS M VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED MSTANDPIPES GENERAL ' EX- APPROVAL SSDS ADJ. LOTS WETLAND ( TOWN/DEC PERMIT REQ? ) LJ DATA ON DDS PLANS & PERMIT SAME E.ZPRE- - NEIGHBOR NOTIMCATION PLOO R BI/ZBA . FLOOD ELEVATION REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE m GRAVITY FLOW CONSTRUCTION NOTES (GRINDER NOTE) DESIGN DATA: PERC AND DEEP RESULTS W /TWO -FOOT CONTOURS EXISTING & PROPOSED AY & SLOPES CUT_ DRAINS [ON CONTROL; HOUSE,WELL, SSDS ON CONTROL NOTE — & DEEP HOLES LOCATED ?SENTATIVE OF PRIMARY AND EXPANSION LOCATION MAP - NO. OFBEDROOMS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM ,TY METES & BOUNDS SETBACK NECESSARY (TIGHT LOT) SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE DS; MAX. BENDS 450 W /CLEANOUT FILL SYSTEMS YBARRIER 10 FT HORIZONTAL: SLOPE 3.1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS IN EXPANSION AREA \1 TRENCH LF TRENCH PROVIDED M60 FT MAX PARALLEL TO CONTOURS 100% EXPANSION PROVIDED d0' TO P.L., DRIVEWAY, LARGE TREES) TOP OF FILL 20' TO FOUNDATION WALLS T 15' WELL TO P.I 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (PITS -20') 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS '15' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2%,35' -1 %,100' <1% 20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. 10' FROM FOUNDATION; 50' TO WELL COMMENTS: 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 # /o WELL LOCATION Street Address Town/Village/City Tax Grid Number ?�, -2- WELL OWNER l Name Mailing � :L � A LU S E Address 1Uf.- �/'�1,{ C - k LL W.Private ❑ Public USE OF WELL - primary 2 - secondary WRESIDENTIAL ❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP ❑ BUSINESS O FARM Q TEST /OBSERVATION ❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY 0ABANDONED ❑ OTHER (specify, Q AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED ,�, � /EST. OF DAILY USAGE- gal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY F3NEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION M ADDITIONAL SUPPLY L3 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING `2SI DEi�� T WELL TYPE ®DRILLED 13DRIVEN ®DUG 1:1 GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO ,IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -'00 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X, NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: jl LOCATION SKETCH .& SOURCES OF CONTAMINATION PROVIDED (ZION SEPARATE SHEET (date) ignature 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 drYwOff*icial ' tions be contained on this property and in such manner as not to degrade or otam to surface or groundwater. Date of Issue: 1.0 19�� Date of Expiration 19� Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller RECORD OF PHONE CONVERSATION Time: `% ; �, 5 A✓"1 Date: Person calling: _ GG Y Phone #:C a "�� l -?_ l< tai' .Teve Reason (fq 11,,~5 Inspection: 42 320, ( ) Deeps and /or P_eres: Scheduled Field Meeting Time: 2 'y n-e Date: ? A ty 0, e, ..� n�u y d e r` 1- +o�CaY 2l/ 3� Y N Tentative /to be confirmed ( ) Town: Road /Street: Tar Map #: I � 1 .— a -- 7 Comments: September 19, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS O'Dell Subdivision - Lot #3 Caroline Drive (T) Patterson, New York - t Dear Robert: Enclosed are the following: - 1. Four (4) prints of SS -3 "Proposed SSDS ", dated 9- 19 -97. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit of Sewage Disposal System ", dated 9- 19 -97. 4. "Application to Construct a Water Well ", dated 9- 19 -97. 5. "Design Data Sheet ". 6: "Letter of Authorization ", dated 9- 19 -97. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Bank Check 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. N' ols, Jr., P.E. HWN: TR: bd 97035 `LAURENT ENGINEERING ASSOCIATES, P.C. _ MILLBROOKE OFFICE CENTRE \ / \ HARRY W. NICHOLS JR., P.E. Route 22 R Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS September 19, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS O'Dell Subdivision - Lot #3 Caroline Drive (T) Patterson, New York - t Dear Robert: Enclosed are the following: - 1. Four (4) prints of SS -3 "Proposed SSDS ", dated 9- 19 -97. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit of Sewage Disposal System ", dated 9- 19 -97. 4. "Application to Construct a Water Well ", dated 9- 19 -97. 5. "Design Data Sheet ". 6: "Letter of Authorization ", dated 9- 19 -97. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Bank Check 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. N' ols, Jr., P.E. HWN: TR: bd 97035 APPL•ICATIO:i FOR APP ROYAL.,. OF -PLANS: FO , R A. V?A S T EWAT. E R DISPOSAL, SYSTEM Name and Address bf.. Appl.1 ca.nt::; V_I N) � A-,-,A L 1!-51) . oLl -Name- of Project: V'120'Q-) 5-r M ..... . _- _Location T/V/C CA-TTeP-S Address: -Millbroo -ke Office Ce n t. 4. -Project Enqineer: tAu CA0 LS . Brewster_.;--NY. .'IG509 914). 2 78-6103 J ne: License N' ur b e r; Ph 9 6.. TYDe- 07 ac.P_L6 _Ct - Private /Residential. va Food Service .•.-Corr-nercial. ri " te/Res'idenial Apartments-:_ �'I n s tI tutional Mobile on e. Park - Office Building .. Real Ly _.Subdiv.is.ion Other. .:,. .(spec'i I -c y) 7. Is this"p'roject subject to State Environmental -Quality.Review (SEQR)? TYDe Status (check. One) .... . Type I.-. Exemot Type 11. Unliste'd. 6. Is -a- Draft Environmental r"onme nt a I n p'act S'a'emen' (DEIS)-.I require d ? 9. H,,- s DEIS'b6en coimpleted and round a c e p t a b I e - b y e a d A e n c y ?. ZA Name or L ea;d' Agency Is this pr-oject, in an area under••Lhe control of -local pl ann i ny., zoning, or other officials, ordinances? ............ F so, have plans been suL-7ii t'ed - o' such 'au'hor.ities? L-'as Prel in, inarIy approval be"L: f-i` 'gr -a 6 t, e- d b -F-U LhO r i t i es? . 'Date Granted: y...such -e rs Type of Sewage Disposal: System Discharge...... . Surface Hater K Ground V11 E�, 1 surface water discharge, what is the stream - class- designation ?......... Niters index.number (surface) .............. .. ........ ................ �,l /A . 7-s locat' project L ted near public water supply syst emi? ...... ............. DisLance to water supply nai.-,e of r�ater supply ZA ,iGJ CL site n:_7ar a publi is selvaqe col lec-"-- ion or disposal Syst;:,-.)? ..... ..Distance to se,,,,age syste-7 C) F s ewaqe sys tem L L Observe.: ?_3 c, rHealth design a 1 Ions P e f - d a ............. ......... . 25. Is State Pollutant Discharge El ini nation. System (SPOES )'Permit required ?.. - 26. Has SPDES Application been, submitted- ',to.',!loca.l DEC- -Off fcie?- 27, is any portion of this project located'w.i thin. a des ign'a`t6d :Town or' State wetland ?........ ... ........................... 28. Wetland ID Number ........ ................................ ...... N 29. -is Wetland Perm, i t. - requ I.red? ................................... Has application. be.en nade.,_:6. Town.'or Loda DEC Of f i ce . .......... . .30. Does- project., require a- DEC Stream'-Disturbance Permit?. f 2 3.1. Is or was-proJect-,-site :used, for.- a'qr-i.dultural activity involving application OT.pesticide5-to orchards-dr-''6ther-crops:,--solid or- hazardous waste disposal landfilling, 'sl'udge application or industrial activity? No 32. is project. located.'within J',Q00 -feet o-f;'existenc.6of abandoned. landfill hazardous waste, salt- .stockpile, '1'zndfi..11,,.slud.g6--d.i'sposaI -'site-6r' any other potential known sourceJ`6T-.'-cokL:a;in, inatfo*n? . ............. :.YES or. NO 1, 2 DESCRIBE: 33. is there, a local master plan -.or.: f le''.-iii th the Town or - villa'-ge'? 2-1. Are co.-,'Dunity water, sever. faci I ities:,plahned to- t be developed within iS years? 'Ar'e any sewage disposal areas in excess of.. 15%- slope?.. ............. Tax:Map D Number ................ Approved, P.1 ans are' to''be: returned to: ................. _,Applicant Enqil f he applicatJon-lis signed by a person other than -appl icpnt shown in Item .1 the'. -L the pplicat'ion must be•accc�mpanied by . -a:., Letter o Auth6r'iiatibn:� ;Failure to comply with t h) s rovision may be qrbundsl for the' reject' ion: of any s u b,-ii i s s ion'. I hereby if y a -n, under p-_na7ty_of.p-_r,jury.;- that infbmation provided on this -'-o rn t belief. False statte—,rents-made- is true to he 'best *o F'M'y know 7&,Yge and be 7 f herein are punishable es a Class A His.de-,eaono, Isuent to Sect- ion 210.45 of the PenF7 Lew. :.`MATURES . , F, & 0::rT TIC-11L TITLES: Mi I It J. J. 6rooke 0,17ice Centre ADDRESS: Brewster, NY 10509 . "I PUnM COU= DEPARTMEW OF i. DIVISION -OF- EWIROMENIMI, IMLTH -SERVICES DESIGN DATA SHEET- SUBSUFACE SEWWAGE• DISPOSAL SYSTEH FILE NO. ' owner J4�y i N menALUS -TE . Address 1 gr -I 1,544ALeT VIC. E fei Located at (Street),,-_ApOL 1 Sec. I Block 2- Lot -7. (indicate nearest cross streetY Wanicipa ity ��'� "j- ! 4 Watershed . O ,, SOIL PERODL? CN_MST DATA REWIRED TO BE .SU&'a'1'I'ED WIM APPLICATIONS Date of Pre - Soaking �'- '� . Date of Percolation Test' 'HOLE Na,.= CLOCK TIME PERCOLATION PEROO=( N Run Elapse Depth to Water ]Fzcm Water Level No, Time Ground Surface In Inches .Soil Rate, , Start Stop -Min. Start Stop Drop In Min/In Drop Inches Inches Inches 2 2 o 5 .. 5 2 .3 12',52• - I ' 11 1 i 5 1 DEPTH G.L. 1' 2' 3' .41 51 • 0 O• ■• • • • • 0, •• HOLE NO. , 6' A• 7' 8' 9' 10' �T M HOLE NO. HOLE NO. 12'_. 1.3' 14' INDICATE LEVEL AT MICH GROUNDWATER IS ENOOQNTERED — INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERFD DEEP HOLE OBSERVATIONS MADE i BY: . V4, W ► G;-I GS J_4Z DATE:'. - - -2a -251 DESIGN Soil Rate Used -! Min/l Drop: S.D. Usable Area Provided • rJODD SC° No. of Bedroans Septic Tank Capacity gals. Type Absorption Area- Provided By L.F. x 24" width tree Other �P��f Ni cr�a ,'5fi. OFESS 'THIS • • USE BY BEAMS D • • v: E= ONLY: • • .. . o M - .. Date A• I 12'_. 1.3' 14' INDICATE LEVEL AT MICH GROUNDWATER IS ENOOQNTERED — INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERFD DEEP HOLE OBSERVATIONS MADE i BY: . V4, W ► G;-I GS J_4Z DATE:'. - - -2a -251 DESIGN Soil Rate Used -! Min/l Drop: S.D. Usable Area Provided • rJODD SC° No. of Bedroans Septic Tank Capacity gals. Type Absorption Area- Provided By L.F. x 24" width tree Other �P��f Ni cr�a ,'5fi. OFESS 'THIS • • USE BY BEAMS D • • v: E= ONLY: • • .. . o M - .. Date � 11 1 1 1� 1 1 H I•. �� ; 1 r- \ �\ • i i i � . °�' / ddb � '� Sao ., ► \ F , ! I . I 1. / ao� d• / /off . o o/ se lol NEW YORK- NEW HAVEN HARTFORD ID mm�SO&"4,340Z 450.00 4 - � ►=-- _AREA TANK 1 3 ° /a P - - 4 0 so</o p V. r, c6ov� LOT No. �¢ O h N.YS. ,P7'•QQJii �C N SIT] PROPERTS TAX MAP: o. b SG3'37 /3'w gZ. 08 C� PROJECT p�0 0WNILOF GA CLIENT PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date !2 (!� -7 Re: Property of U.ST�i2- Located at Ln ro) ,-Yk t-- V( -V P— (T) Section I � ' Block 2 Lot _ Subdivision of O' � (� Subdv. Lot # ?j Filed Map # 121,_kj Date I i) Gentlemen: This letter is to authorize-Harry W. Nichols, Jr., P.E. a duly licensed professional engineer, 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 promulgated 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_.m �� pF NEW. rC� AQ IA r�ic�o'N 17 % r c� County Sanitary Code, J— PJo.5024 4 igned: vAROFESS19% 4 Very truly yours, ' G Signed Owner of Properly P.E. r\(eu 7.,2 1f ; Address Address Town Telephone l� rzl�) Telephone DIMENSION CHART (in ft.) No.I A m: ,— 17. 41.0 2 36• 0 43.0 3 39.0 43.0 5 79. G9 0 75.0 6, 6. 7 77.o 7i.0 8 /23.0 //7.0 9 /23.0 /09-0 /0 /Z4.0 0 5 73 oj 6,30 E 78-90 J� m� 5 74044P'10"E 52 43' r i