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HomeMy WebLinkAbout0361DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -74 BOX 5 . 1 l , V4 . � i r , AIL No IN yl t IN r : IN � � IN ti - P, 00170 i PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEAL'T'H SERVICES CERTIFICATE OF CONSTRUCTION COMIrLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 4C j% iAGu_PY /e:_,Vc/ llgi ✓� owri or Village Pig ;7 eS0-,/ Owner /Applicant Name C1_,V65 1G kVIS dwl, Tax Map 13 Block 7— Lot 7 Formerly Mailing Address Date Construction Permit Issued by PCHD Subdivision Name 0 '1115WI4 t1 Subd. Lot # N Zip X425 -DC Separate Sewerage System built by G ✓l 5 F Address , o?,g Box,3S52 13 y nele N" /fl5�b Consisting of Z`SV : _ Gallon Septic Tank and e� 7 G /y, `% Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by M /LL Z�zjZ LC /iIIG Address T ,gill, Building Type Has erosion control been completed? Number of Bedrooms `� Has garbage grinder been installed? N U I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the ards, rules and regulations of the Putnam Co D artment of Health. Date: Certified by P.E. R.A. QQ (D n Profession) ,/ — Address �9 �U S'/it��l, N jD% License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m dificati change is necessary. By: Title: 98C Date: �r White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 { <s D a 'EA,h NORTHEAST LABORATORY of DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LAW (203) 748 7-7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING DATE SAMPLE COLLECTED: 10 /8/98 & 10/14/98 75 PUTNAM AVENUE TIME COLLECTED: 4:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 10/9/98 & 10/14/98 TESTED BY: LAB# 11471 & 11301 REPORT DATE: 10 /23/98 SAMPLE SITE: CLASSIC HOMES, LOT #11, RIDGEVIEW EST., PATTERSON, N.Y. SAMPLING POINT: TANK SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: 10/14 -Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 7.27 no designated limit Turbidity 2.0 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N 11301 -Nitrate N 0.25 mg/L as N 10 mg/L as N Alkalinity 116.0 mg/L no designated limits Hardness 132.0 mg/L no designated limits Iron <0.03 mg/L 0.30 mg/L Manganese 0.016 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 3.0 mg/L 20 mg/L ** Lead 0.005 mg/L 0.015 * ** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 10/9/98 & 10/14/98 SAMPLE, AS TESTED ABOVE: AMP OTABLE or OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) c Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 x NORTHEAST LABORATORY of DANBURY 39 -3 MILL PLAIN ROAD DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 CT Cert: PH -0404 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. DATE SAMPLE COLLECTED: 10/14/98 75 PUTNAM AVENUE TIME COLLECTED: 4:06 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 10/14/98 DATE(S) TESTED: 10/14/98 TESTED BY: LAB #11471 REPORT DATE: 10/16/98. SAMPLE SITE: CLASSIC HOMES, LOT #11, RIDGEVIEW ESTATES, PATTER_ SON, N.Y. SAMPLING POINT: PRESSURE TANK SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: RECOMMENDED LIMIT BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - -- ml = rriliiliter mg/L = milligrams per Liter ND = none detected RESULTS BASED ON SAMPLES SUBMITTED: 16/14/98 SAMPLE, AS TESTED ABOVE: MOTABLE or FE POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 r - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location lWell Street Address: Cross Road, Lot 11 Town/Village: Patterson, 'NY Tax Grid # .7L/ Map Block Z Lot(s) -44- Owner: Name: Address: Classic Homes .& Development, .c /o Al Finn, 19 Salmons Hollow Rd,, Br.ewste Use of Well: 1- primary 2- secondary xxx Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) T Industrial Institutional Standby Drilling Equipment Rotary Cable percussion XXX Compressed air percussion Other (specify) Well Type Screened Open end casing xxx Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 7 —ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: xx Steel Plastic _ Other Joints: _ Welded � Threaded _ Other Seal: xx Cement grout _ Bentonite Other Drive shoe: xX Yes _ No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Xx Compressed Air Hours 6 Yield 25 gpm Depth Data Measure from land surface- static (specify ft) 20 During yield test(ft) 200 Depth of completed well in feet 260 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft.. Land Surface 5 Brown soil .w /cobbles 5 20 Soft. white limestone 20 30 Medium to hard limes tone .30 . 260 White limestone If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 260 .25 Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed .7/31 /98 Putnam County Certification No. 2 Date of Report 8/1:4198 Wel r' er 'nature NOTE: Exact location of well with distances to at least two permanent landmarks to be pro 9d& pt Ac #d4j4e ftbsi dent We1lDriller'sN I DRIL NC: Address75 'Putnam.AVe.,'Br.ewster, NY Signature: Date: V1:4/ 98 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NY fli.. NORTHEAST LABORATORY OF DANBURY ' CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LABS (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING 75 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: DATE SAMPLE COLLECTED: 10 /8/98 & 10/14/98 TIME COLLECTED: 4:30 P.M. COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 10/9%98 & 10/14/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 10 /23/98 CLASSIC HOMES, LOT #11, RIDGEVIEW EST., PATTERSON, N.Y. TANK WELL -NEW NONE RESULT: MAXIMUM CONTAMINANT LEVEL 10/14 -Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 7.27 no designated limit Turbidity 2.0 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N 11301 -Nitrate N 0.25 mg/L as N 10 mg/L as N Alkalinity 116.0 mg/L no designated limits Hardness 132.0 mg/L no designated limits Iron <0.03 mg/L 0.30 mg/L Manganese 0.016 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 3.0 mg/L 20 mg/L ** Lead 0.005 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 10/9/98 & 10/14/98 SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) u� V Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800- 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot GG195 S/. -,, - 5 �, 4),ev- Building Constricted by Cinoillage Location - Street S INt Building Type e, //"w 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 o not t ailure of the system to operate was caused by the willful or negligent act of the occup t of the b 'lding utilizing the system. f j Dated: KoRIN Day Year General C6Rfactor ) - Signature Corporation Name (if corporation) Signature: \ Title: 06 Corporation Name (if corporation) Address: eta kk_�i dd State Zips State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: aS �8 Street Location Inspected by: _G, Sze y ipag �j�� Xblzlvc Owner 1�c to HAKA Town 194TTEzz5ee,N Permit # 7> — 5'1 — 93 TM 13 — 2 -7# — Subdivision Lot # f f " O `fl Ali 1. Sewage System Area a. STS area. located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier . Lgth.- Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage Svstem a. Septic tank size - 1,000-........ 1, 250.......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation..: ...................................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. INfinimum 2 ft.Original soil between box & trenches Junction Box j properly set set ....................... ............................... Length required �6 6 g Length installed 2. Distance to watercourse measured-✓' 2 &2o Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 =1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % .......................... 8. Size of gravel 3/4 -1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. PUMD or Dosed Systems Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade.: ............... 5. First box baffled .......................... ............................... 6. -Cycle witnessed by H.D.estimated flow /cycle.......... III. House/Buildm 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 4-- /DB ft ........... c. Casing 18" above grade ............................................ I..... d. Surface drainage around well acceptable ....................... V. Overall Workman'shin 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 & dir.to exist watercour g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .. ............................... i. Erosion control provided ................. ............................... Rev. 1/97 lewi.- WON- wowi APPRO, m Re: PUTNAM COUNTY DEPARTMENT OF HEALTH' DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Property of Located .at ZJ06f (T) A �• 3 �Lot L/ Subdivision of e� Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer or t_ (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. leiCountersigned:`t���iy, i P.E., R.A., #__7' Ko 3 o2 �. rAddress 776 -5-773 Telephone Very truly yours Signed �---�y caner Property Address r Town Telephone 7 DEPAW OF �ALTH lb as OF CONMUAMM Lost Am I.0 2� 4-y' 3111mbe Nwaier al Bednieliiie`� 'Dedgis Flow G'P D dU sdlaiiasdeuwspaps�iiiiiawenddet S11111111ft Tank AM 010� my Water SEP*! Pine Saplb.Fires on Le, S11111111b Domed above dncpb0d,wi!! ",Constructed as Sh"A ", the approved 4MG County ` DePaIrtmelt that on Coetplatiori thereof, be submitted to the .Dqwrtrnent.'and: a -,winiot 4uoanti 'wlll PIM. in good'' _'Ad if ­ 4d sewije �dll , operating -to Rion any part 9 , a ante of.the'appieval of -thi'eoirtificats'of"Conitrtiction' - "Compi WIN be I bested appr"oveOlan and that isid.will wi County Do" f "MR , Data co. _44;-" Sig ' APPROVED FOR CONSTRUCTION: This OPPrOvOl GxPirINS two Y 0014"ble, for cause iDi may be'arnsiiW46 or modified when *ionskl ­ ­ : " 64,W 'for dliPo"l 6616 ki ReV.. require& a new it., Apor, . Seri 10/88 sub -4 aiil6risi6f Health Will that said bulkiff will I the*41ail! Of the iNu- wowdeicriboil above is 'of the Putnam oars from . '�the.. date -issued unless constructi" of the building has been undertaken and is sd� na"ssa�,!y, bi y', the C6rnmissiono' of k"i'm 'Any change 'or alieratboii.oi construction Itary a , to supply only. Title 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 otreet dress Town Village City .'er Tax Grid Number WELL OWNER Nam Mailing Address ©Brivate 0 Public USE OF WELL 1 primary 2 - secondary Q MIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND/H AT PUMP 0 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, ❑ INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED /EST. O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 04E-W SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL OF DAILY USAGE 60 Sal GIADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING U WELL TYPE ILLED DRIVEN DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �40 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C-2 UAP-4z, Lot No. \ WATER WELL CONTRACTOR: Name F'J Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCNOMN SSEPARATE-SHEET OURCES OF CONTAMINATION PROVIDED d (date) V XTdignaf6r'e)_ 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 am' ate surface or groundwater. Date of Issue: 19 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 eras Ty" 4S ALI IM Ntf bw of Beillimens, Q--' Design Flow G P Dom_ Sops gate SoWMgP System ti Comm et SgWk Te a To be:emaasselea.by _L2 Adlhaae &be" described will t County Department be submitted to the place -in tad .ope►al aria of the approval will be located is die_ n County depart Dote If�l iC APPROVED FOR CO revocable for cause or "quires a now permi Rev. .10/88 kf at shown on 't 4 app(ov and that on compkition t t. and a written quarant on,. any part of .hid : -saw rtifk;ate, of Construction Ip►ovad -plan and that said ,for disposal of,domes[k qn and location of. thIe proposed system(s); 1) that the separate .sawn a dis osat s stem tment thin to and �in accordance with the standards, rules aln 'Iegu a ona,o , s n "Certificate of Construction Compliance" satisfactory to the Commisslorwr of Malthwill e- furnished the owner. his succosSW , hei►s,or assigns by the builder. that said builder will ot al. `system durirq the'pebd of, two (2)' f immediately following the date of the )ssu- ince Hof the 6r4inaLsyst�n►`or any r t eto; 2) that the drilled well deserlbed a6oue be Instal in.:ac den with a d rules and rogu a� MZns of the Putnam W pxE It A. IU I License No ►s from the date issued unless construction ' f the building ft., been undertaken and is W necessery - by'ths .commissioner of Health. Any change or alteration of construction , a►yT aqo, ** private .water 'supply only. . Title >�'� 'J 1.. e/�V I AVl•1 G •iL.iV.• u.n./.�wu...0 .Wa"JAL• L/LI \Y 1L1A) 44L I . DESIGN UAT11 SUMr- SUDSUEACE SUTAGE DLSEWAL SYS'1121 FILL M. tuner PETER 01HARA Address P.O. BOX 282, PATTERSON, NY Located at (Street) ROUTE 31 1 /CROSS ROAb Sec. 10 Block 2 Lot .1 1 (indicate nearest cross street) ikwlicipality PATTERSON Watershed - CROTON SOIL rEROOUMON TEST DATA IMUIRM TO BC SUi1N 1117M WMI APPLIClY1' MS Vato of Pre - Soaking 9/07/88 Date of Percolation Test 9/08/88 HOLE I RI•MM CLOCK TIME PEItCOU TION FERML hTIOU Run Elapse Depth to Water Fran Water Level Ho. Time Ground Surface In Indies Soil Rate Start-Stop Min. Start Stop Drop In IlLn /In Drop Inches Inches Inches 1) 1 11:06 -11:24 18 24 27 3 6 2 11:24 -11:48 24 24 27 3 8 3 11:48 -12 :12 24 24 27 3 8 4 5 .2) 1 11:08 -11:38 30 24 27 3 10 2 11:38 -11:58 30 24 25.25 1.25 24 3.11:58 -12:28 '30 24 25,25 1,25 24 4 �i • r.°1��: . 179, _ < r , p7,Ari- • • .............. MIMS: 1. Vests 'to be repeated" at came depth until approximately equal. Goil rates are obtained .at each percolation test Dole. All data to W suhnittAd for review. 2. Depth measuramtits to W made fran top of Inle. rev. 9/05 ` UI::PlI l 6.n 12" 1800 24" 30" 36" 421" 48" 54" 60" 66" 72" 78" 114" O'HARA SUBDIVISION TL•' T VII UATA lW-JUIRW IU UC GU1141 -TrW 1.11111 ALTIA(JYrlutl SECTION 2 ULSCILLI'110N OF 001W IZJ MNl'QUI) IN 'LEST IIULI i IOLC 110. 11 A 0 -- BROWN SANDY LOAM 110LC 00. 11 B 110LE 0j. Brown Sandy Loam 311MC 1ZE LEVEE, AT WBICH GROURiMUM IS Fr I OUNTEPIM None 11-101CR1E LEVEL TO WHIC1i HRTER LEVEL RISES AFTEEI BEING N/A DEEP 110LE ODSERVATIMS MADE BY t J. F. E B E R L E DWZ: 9/6/88 DESIGN Soil hate Used 28 HWI" Drops S.D. Usable Area Provided 8004 S. F. Ilo. of Dedroca s 4 Septic Tank Capacity 'U 9 Z 24als e . Ty' Absorption Area Provided By 667 L.F. x 24" width trends 7 Other. Alternate design or dosing required ••" "' Ham BALDWIN & CORNELIUS. P.C. Signature• TA !k]dress RD 5 . Route 22 SPAL �`. 1980 = �� ISI • Brewster. New York 10509 �'�•�� �'EW `I� ��'� oAROfES 1501 1111LS SPACC Mt use BY tlr• All DEPASt IMM Q4LY: '''•,,,..,..,.,•••'•• Soil ita.te tffroved sq. f t/gal. Checked by rc � .w�J DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO'CONSTRUCT A WATER WELL g —1-1.1 PCHD PERMIT # ' WELL LOCATION Street Address ._ Town Village City Tax Grid Number ._ WELL OWNER Nam q�,, Mailing — v , Address 2 . rivate O Public USE OF WELL 0- primary 2 - .secondary aRRESIDENTIAL 0 BUSINESS 13 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PU4 O FARM O TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT" _gpm /# 13 PLACE EXISTING SUPPLY EM _W SITPLY DWELLING PEOPLE SERVED e5 /EST. OF DAILY USAGE 46gal O TEST/ OBSERVATION L3. ADDITIONAL SUPPLY Ll DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING '- WELL TYPE DRILLED DRIVEN ODUG GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: U Lot No WATER WELL CONTRACTOR: Name 'r; A�3, D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES °ENO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N'.SEPARATE SHEET O i (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 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_� Permit Issuing 0 fficial Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date t I t ! l � -,t> Re: Property of Located at_� (T) -r tit - et e Block '�dp� Lot ^ Subdivision of Subdv. Lot # `t Filed Map Date ✓L T.. M ICHAEL DALY, P.E. Gentlemen: ., CONSULTING ENGINEER P. 4: $OX 243 This letter is to authorize SHF.NnRn('KrN �5g7 a duly licensed professional engineer V or rg,isterP gN!•�,; +�„�,t (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. Very truly, yours, ned Countersign e�l�i� Owner of Property P.E., R.A. , # `Z Address T. MICHAEL DALY, P.E. �� 6 0 Address P.0. BOX 243 Town SHENOROCK, N. Y. 10587 % d � "Telephone Telephone v UT NAM COUNTY D E PARTM ENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER, DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: 1&1 - 3. Locatior(fvv/C: 4. Project Engineer: i 5. Address: � K Z �� License Number: Phone: —OSO 6. Type of Project: Private /Resident Apartments Office Building 7. Is this project subject Type Status (Check One) ial Food Service Commercial , Institutional Mobile Home'Park Realty Subdivision Other (specify) to State Environmental Quality Review (SEQR)? Type I.. Exempt Type II. Unlisted S. Is a Draft Environmental Impact Statement (DEIS) required? ............. f�IA 9. Has DEIS been completed and found acceptable by Lead Agency? 10. Name of lead Agency 11. Is this project in an area under the control of local planning, zoning; or other officials, ordinances? ......... ............................... 12. If so, have plans 'been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? Date Granted: ^ 14. Type of Sewage Disposal System Discharger r. •6. oF- Surface Water Ground,Waters 15. If surface water discharge, what is the stream class designation ?........ _ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? 18. If yes, name of water supply Distance to water supply !9. Is project site near a public sewage collection or disposal system ?..... ,0. Name of sewage system Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) .......... CC�.) .................... z. - 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. b { 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State ,1 wetland? .... ............................... ....... N 28. Wetland ID Number ....... ............... ............................... 29. Is Wetland Permit required? ............. .... s" ... ..... ..... ... Has application been made to Town or Local DEC Offfcen 30. Does project require a DEC Stream Disturbance Permit? ... :....... 31. Is or was project site used for agricultural activit? involvi�ng;applicatiow of pesticides to orchards or other crops, solid orftazardous watte'disposal, b landfilling, sludge application or industrial activity? ......:. YES or °NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste' site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO Tk V DESCRIBE: ' 33. Is there a local master plan or file with the Town or Village., .........:. `- 34. Are community water, sewer facilities planned to be developed within 15 years? �b 35. Are any sewage disposal areas in excess of 15% slope? 36. Tax Map ID Number ... .............................'. 37. Approved Plans are to be returned to: ................ Applicant ''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 may be grounds for the rejection of any submission.;'- A I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. fa Ise statements made herein are punishable as a Class A Misdemeanor pursuantr.. o Section 210.45 of the Penal Law. SIGNATURES 8 OFFICIAL TITLES:i MAILING ADDRESS: _3f�X `7� `J�10ZoL� Q) 4 1 T. MICHAEL DALY, BOX 243 SMORO.CK, RX. 41�DROOM GOLOI�IIAL*' S I N67LE FAMILY RES FBI 1 24' G L. BDRM #I 'GL. G L. BDRM #2 BATH BATH ROOM. v. 0 GL. t/11 GL. HALL. - BDRM #3 MASTER 5DRM 04 _-j um v8„ _ 11 -o„ PUTNAM COUNTY DEPARTMiENT OF I4FATT HOUSE 'DT ANS APPROVED F`JR 1/8" = 11-0" •-f t DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Sean Daly Box 243 Shenorock, New York 105 87 Dear Mr. Daly: BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 11 (T) Patterson Retiiew of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments ate offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New Fork, Title 10, relative, to the need for approval of individual sewage disposal systems by the Go%, of New York. You should contact city Officials in this regard." ,1) Engineer'ls Authorization has not, signed by the property owner. ✓2) Trench cover is to be noted as aeotex-tile. ./3) Erosion control measures are to be shown and detailed for the house well and SSDS. Furthermore, a note is to be added stating all erosion control measures are to be installed prior to the start of any construction. J4) Plan has not been signed and sealed by the design engineer. Upon receipt of a submission, revised to reflect the above, this application will be considered 6 IIV � RMlmh watershed c; rG YIGt 4U Y6'__ �� � �� +may � � � truly yours, uy/m000 Robert Morris, P. E. Public Health Engineer F, Ill. 1O' MIN. ........... 14, SHOAN Kill, i a PROP. 5505 % NO �S ITMLL 100, 4 IN. 1250 AL. MA50 y 4" GI 5EPTIr- "/r-T. TANK U5 N. N:24'451:2*7,:C- Soo 'ND 55D5 PROP LEAD FOOTI S?RAIN HAIR 490 480 Y7 .y 2,i,. r �- z-- ::S 3 Wiz:' .. - s .- � �-.. ?4��' yS,• h Yx J� �. �,.•', .t,' L. 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