Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0364
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -77 BOX 5 I L r - ;; lu 4 '14d. ul ti 0111 ' T � it i 00173 1 a's LORETTA MOLINARI `nr Public Health Director Nursii Kenneth Kupetsk- 27 Ridgeview Patterson, NY, 125E Dear Mr. Kupetsky: ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 gervices (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 riv Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 August 22, 2003 Re:Addition- Kupetsky, 27 Ridgeview Ave. No Increases in Number of Bedrooms (T)Patterson, TM #13 -2 -77 - I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the :addition has been approved as per plans bearing the approval stamp from this Department dated August 21, 2003. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson.. If you have any questions, please contact me at your convenience. WH:lm cc:BI Very truly } urs, . William Hedges Senior Public Health Sanitarian PP777 -- pq Awn � 0 "K%`� n 9 , � � � \� pow w tot? wt> 0 t I., k ;4. ?yx A Wat Any W", MY \�� /�} . MAW }� � \\ ���� \\ &A ski -Av J 01-l" DEPAR i MEIv i OF HEAL.TIH DIvf.rion of Environmental Health Services 4 Genava Road Brewsur, New York 10509 M.. (9 14) '278.6130 Fax (914) 278 - 7921 BRUCE K FOI.Cy Public Hecitlr Direc:c- STRTE - ,�. TOW`S' TX MAP # Of N,-,*m &ai wzir" PHO-N-E ggaliD IIVIAIM(a ADIDRE53 DESCRIPTION OF ADDITION R \L�IBER OF EXUST-LNG BEROONLS � PROPOSED 4 C BE M (FROM CERT. OF OCC PAl1Ct OR CERTIFICATIO'i FROM BUILOLNC N"SPECTOR) *Any addition «-hich is coder and a bedroom requires formal approval of plans (Construction Permit) prepared by a - rcf_ssiornal Engir-eer or Registered Arc'nitect in accordance with anrlicab:e sections cf tlit Pu=, C0'nnty Sanitary Code. Please submit this fc= ar;.d the fo;lowing to P,&am County Health Dept., 4 Geneva Rd., Brewster, ly 10509, Phone 27g• M. 1. Certified check or money order for 5100.00 Sketches of existing floor pia.ri (drawn to scale,. all Eying area Including basement) " Non - professional sketc'n._s arc accept=ble 3. T.wo sets'of proposed Loor plan (drawn to scale, with name, street., a :d tx. rnap T) * Novi -pro -6simmAl sket,hes are acceptable 4. Copy of survey showing well and septic location, to the best of your k:,owledge. Include date of install°tion if k io-- vn: Label all wells and septic syste:rs withLn 200 feet of the property line. Contact this office wit, any question. 5. Copy of len. of Occupancy frcm Town or Certification from Buildirg Dept. with legal bedroom court of dwelling. OFELE USE Co:nrne1ts r:b 93 DEPARTMENT OF HEALTH Division . Of Environmental Health Services 4 Ceneva' Road, Brewster, New York 10509 (914) 278 -6130 BRUCE R._FOLEY, A c Acting PuhEfa Meatch, 0�- •:t.�r Puma —... County Dept. of Heait� 4 reitava Road 3:CwSSCr, NY 105C9 Re: Resi ence Tax Map Town_ C:entlrmel: ` g ' r r i r ' ' by the Tovti l �, the above noted d`�, etling ?,,cc►din �o .e;,c.ds ma.il.a�r.,�d is .S NOT in core Banc �<ith Totiti coc+� and the total number of'oedreoms on recd d is This information .gas been obtained from.: CERTIFICATE Or OCCUPANCY: A SESSORS RECORD: G.y HER r .Building inscector F- 04 m/ 0i 0 143 'Pro po<6 , `Plan, STORAGE 13!9 x 13'1 ......... ............ 43! ..................... --------- .......... ....................... ENTRY OFFICE 64 x 8'- 291Ox12'11 UTILITY 0 j 9'2 x 8' BATH 5'8 cm 6' x 8' . ......... ------- ----.-.-------------- FAMILY 20'4 x 18' 0 0 0 UP 0 1 41 O -43'- LIVING AREA 1161 sq ft OUTNO CO= DEPARTEW OF W1W 'UMSE PLPYS APPROVED FOR SEDROON COUNT ONLY; -iro &Title hv)C+h a-, �;�ig- evt����. -occ-tt c r5 0 n- IV— ON PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # cy- ` 3 Located at i 4 e lei C .e,, Town or Village t 4? / �Ir S v 5 Owner /Applicant Name t a C o Tax Map Block Lot -7 Formerly 14 a r' ±% Subdivision Name � i a Subd. Lot # l Mailing Address 10, C' ..� �a i°�T f� ±. Zip. Date Construction Permit Issued by. PCHD / .-, . 0 Separate Sewerage System built.b Y D,�, Address P, 6 ; 1?e,r x`0 tf,", 4 , Consisting of Gallon Septic Tank and f` i/ Other Requirements: Water Supply: Public Supply - From Address • Private Su 1 Drilled b. ., G or. �.�-• Pp Y Y � �c�.� � � Address �� 11� J Building Type f le -=4i ,�. ,, �, ,, Has erosion control been completed? YC 5 Number of Bedrooms Has garbage grinder been installed? ko. 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 standards, rules and regulatio s of the Putnam Co ty Department of Health. f r Date: ,11 • �. -o Certified byt. t P.E. R.A. ldsip Profe si nal) 4 Address `� „"° i;. "�� License d . 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 ar subject to modification or change when, in the judgment of the Public Health Director, such revocatio0' mo ificati . ,or change is necessary. By: Title: 3 ,4 1'-°"'. Date: I ? /J r1' a White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 First Floor 4a.a a Second FIM MAY b 9 Mohm Family living Room 9 L B M Bath 8�droom +n ®odroom b 9 W. 12430 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4f.* WELL COMPLETION REPORT Well Location Street Addres : ' L Ve To n/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: Eta/ Address: ;i b e rS Use of Well: 1- primary 2- secondary _ Residential Business Industrial Public Supply Air cond /heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby (Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 'ft. Length below grade c2O_ft. Diameter _7 in. Weight per foot j7_Ib /ft. Materials: Steel _ Plastic _ _ Other Joints: _ Welded breaded _ Other Seal: _ Cement grout Y Bentonite Other Drive shoe: _ Yes No _ Liner Yes No Screen YDetaib Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes--No Hours Second Well Yield Test Baited _Pumped JL Compressed Air Hours Yield �Q gpm Depth Data oasure from land surface-static specify to cif During yield test(ft) &1%* Depth of completed well in feet 16::!� 1eccL — Weil Log If more detailed information descriptions or sieve analyses are available, please attach. Depth Front Surface Water Bearing. Well ,Diameter(in) Formation Description ft. t1t. Land Surface I I& ' & �.., If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity 1 "1014 Depth 1,06 Model/6(9 5 O j Voltageg:?'6 HP :�i- Tank Type !!.tPo ,u) Volume X.1c`3����++ Date Well Cymplevd .� l Ol0 Putnam County Mification No. 007 Date of Rep rt �'o 6U Well Driller (signature) ita NOTE: Exp location of well with distances to at least two permanentlandmdrks to be provided on a separate heet/plan. Well Driliees Name �i� e _ Address: / _3�✓ �. erscH Signature, Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 i€..i.� ; € z. = _ iii iit l � -• -ti\ . bit i i 1ii . MST CERTIFICATE CERTIFICATE OF OCCUPANCY AND COMPLIANCE Zvftm- of N° 2761 W 2000 DATE ISSUED November 3, THIS IS TO CERTIFY THAT D. F .W . COWS-tAuction ON THE PROPERTY OF Same LOCATED ON 27 Ridge View .VAive HAS BEEN SUBSTANTIALLY CONSTRUCTED TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK AND MAY BE OCCUPIED AND USED AS Singte_ Fami..i'u Wetting w /Wood Deck Building Permit Dated .6:28 -00.. Permit No. .29 !.... Application No. ...... ?M5........... SECTION ........ .......... BLOCK ...........? :......... LOT.......... 71... I S : D. tot N 14 ) FEE $ 25.00 l • &AW BUILDING INSPECTOR N Tj Putnam County Department of Health I DRAWING A t DIMENSION CHART (in feet) Number A Q 1 435' 1� 2 13(x' 131' 3 142' 1�q' 155.5' ul to ► 00 LLJ 13 1 31.5' l F4' 14 13.5' 120.7' 15 143' t Z�,S' { f M V /I N I�b PUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # p T3 -- 93 Located at i e ✓1 cw & I v-e-, Town or Village Ar / / rs. as Owner /Applicant Name �ty', (�ri�►� �,,,,,�11�,., Tax Map _ jam, Block 2._ Lot -7'7 Formerly_ o ' /4-a rq Subdivision Name 0 1 Subd. Lot # Mailing Address 11, ��a� -f xa , � -,�„� �,, � Zip I 2S Date Construction Permit Issued by PCHD !O-X- U G Separate Sewerage�System built by Q, E, tv, ,s , Address A.0 m I,?ox '` ,90 P,,,&,;gs Ay, Consisiing of I :.q-0 Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From Address or:_je:, Private Supply Drilled by Address 1616 &3 J j /04&C.4" Building Type rs I. �,� ('G, Has erosion control been completed? YrIs / Number of Bedrooms Has garbage grinder been installed? /ya 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 standards, rules and regulatiogs of the Putnam Coynty Department of Health. Date: 11 - - 2 -0c) Certified by P.E. !/ R.A. Address 90 i f, '4Q_ License # . 5� 12-4 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m r ificat' r change is necessary. By: ��^�J Title: "CA" Date: h White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 �;M7Ms'MPMiMt .. t AAIMtlM] McAA/ 11AtlMPM! M` Mt NAil 1A3M "M3M;MaM'iAPrMZM ?M'7M6MSMeMiM MFMeMiMSM9MSMIMiM IAA' "iMZM WON /1tMlMiMtlM i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES / Kf*- AL WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Map 13, Block .2 Lot(s) 7 Well Owner: Name: Address: ,OEW Z ► a a a e rs Use of Well: = primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion ,( Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock — Other Casing Details Total length ft. Length below grade _c2O ft. Diameter 7_in. Weight per foot _jLlb /ft. Materials: Steel — Plastic _ Other . Joints: _ Welded hreaded — Other Seal: — Cement grout . Bentonite — Other Drive shoe: _ 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 Compressed Air Hours _ Yield d gpm. Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed iiformation descriptions or sieve analyses are available, please attach. 1 Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface O r If yield was tested at different depths during drilling, Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 1 .11 . Capacity ,/", hl Depth /�0 f Model /6 Voltage ,,a6 HP Tank Type kkIlXti^v) Volum 6dlch Date Well Complet d 4! da Putnam County Certification No. 007 Date of Rep rt d0 Well Driller (signature) ,NOTIi': Ex jct location of well with distances to at least two permanent xanamarxs to oe pruviucu 011 a sepala� l"Llplwl• Well Driller's Name Address: / 3// P eCrdtr �' e Signature: Date: llKlljb White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public .Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: K1111-ilie� GLJ . 13, - 2- Co, v;� 7 /L l q c- lit t;r.t/ e v e. AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 2 150 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the'above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) r N� NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 IrAB3S (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 W1AXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD • Total Coliform (Bacteria) LABORATORY REPORT per 100 ml REPORT TO: 0 per 100 ml PHYSICALS: D.E.W. CONSTRUCTION DATE SAMPLE COLLECTED: 10/30/2000 P.O. BOX 420 TIME COLLECTED: 9:00 A.M. PATTERSON, N.Y. 12563 COLLECTED BY: DANNY FINNEY • Odor DATE RECEIVED @ LAB: 10/30/2000 - DATE(S) TESTED: 10/30/2000 - 11/1/2000 6.61 TESTED BY: LAB #11471 No designated limits REPORT DATE: 11/1/2000 SAMPLE SITE: LOT #14, RIDGE VIEW DRIVE, PATTERSON, N.Y. 5 NTUs SAMPLE POINT: , BATHROOM SOURCE: ' WELL -NEW • Nitrite Nitrogen TREATMENT: NONE EPA 354.1 W1AXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 1 - EPA 110.2 15 • Odor ND - - 3 Units •, pH 6.61 - EPA 150.1 No designated limits • Turbidity 0.77 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 2.43 mg/L as N SM 4500D 10 mg/L • Alkalinity 310.0 mg/L SM 2320B No defined limits • Hardness 368.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L, • Sodium 9.4 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.006 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL=Maximum Contaminant Level " "Notification Level * "Action Level COMMENTS: -All holding times (were) met. - SAMPLE, AS TESTED ABOVE:. X� OTABLE or OT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 10 /30/2000 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 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 &Xj" Telephone (845) 2794003 Fax (845) 279 -4567 November 2, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Boulevard o Brewster, NY 10509 ,, RE: Individual SSTS Compliance A.-, RidgeviewDrive Patterson, MY. T.M. #13. -2 -77, Permit #P53 -93 4 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built SSTS," dated 11 -2 -00. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 11 -2- 00. 3. "Guarantee of Subsurface Sewage Disposal System," dated 11 -1 -00. 4. "Well Completion Report," dated 9- 25 -00. 5. Laboratory Report, dated 11 -1 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 7. E911 Compliance Form. If there are any questions concerning the enclosed, please call. Thank you. Very truly yours, H W. Nichols Jr., P.E. HWN:his 00- 141.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM DIU, aAL"�- L a. Owner or Purchaser of Building Tax Map Block Lot 1.21� e.— P4 /`J firs' G `1 Building Constructed by TownNillage 4 Location'/- Street Subdivision Name i2c'5' 1'JtA_+Le, Building Type 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. �� r gV, Day 1 Year ao ,10 Signa / Title: General trac r (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: �t r,� ✓'�`'d -c, Address: State Zip 12.5 Gz , State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 0 /5-/&1 Inspecte y: a, TZ c Street Location K, Vl,�w r_>)2, Owner D Town P/,t 7 —_,c 5 ©^i Permit 4 6-S 2:3 TM # - a. - -7 °7 Subdivision Lot # /- o'�f,�,� 1. Sewage 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. Sewage System a. Septic tank size - 1,000 ....... 1, 25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box . All out e -r is at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft-.Original soil between box & trenches e. Junction Bo - ;properly set ........... ............................... f. 'trenches T.-Len�h required 6-71 Length installed 5-74 2. Distance to watercourse measured 4- 1 a 0 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' /Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ................................... :.................... g. Pump or Dosed Sy§te�ms I. 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/Buildin a.. House located- per approved plans.. ............ b. Number of bedrooms ....................... .9.X . ............ IV. Well ail u,� -544%r5 a. Well located as;per approved plans . ............................... b. Distance from STS area measured J !Z0— 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 ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. F Y Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 Date: 1D1 G %a 9 — To: #4 -1Z R1 j Fax #: �Z 7 — 'Y'5-4 7 'IZ!'i7yi t,✓ t7;Z, No. Pages ----------- - = - - -_ -------------- - - - - -- - - -- ---- - - - - -- cludin� cover�sheet . . For your review Attached as requested In the event of transmission /reception difficulties,, please contact thi4 office-at:---- i- * . ` PUTNAM COUNTY DEPARTMENT.OF HEALTH DIVISION OF ENVIRONMENTAL I3EATLH SERVICES FIELDACTIVITY REPORT Nn. G ®� / _ —,ZlDA 1//,Q41 gT�T)R F C C; I�G( G✓2, = �.9"T'7`�'2.t/ " fir, - Street ;Town ,State s Zip ts. PERSON IN CHARGE` I OR TNTF.RVTF�lFT1 0 Z Tate 'Mine and Title : - F .���,� TYPE OF FACILITY / L L F.- INDLNG -`- .s s wIQ e ' „ .a - a •_. — _ r jN4PFC°TC)R; TFT; Signature:and Title RFP.nRT RFCFTVPD AV.-' - _ - I,acknowiedge receipt of this report:,'- SIGNATURE; 02/96: _ .. Title.` BRUCE R FOLEY Public Health Director . LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: 72t1�� i/�EG/ ?�7?. P�Ernoy From: Gene D. Reed Putnam County. Department of Health For your information For your review As discussed Fax #: a79- 1/S6 `7 No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages 1 G L PA 1!91 e, In the event of transmission/reception difficulties, please contact this office at (914) 278-61X ext. 2261. . -- tea - -e ry 44,6r 00- P11.00 PUTNAM COUNTY DEPARTMENT OF HUMN DMBZON Of E1! MONMENTAL HEALTH SETMCES ATTENTION © AiDAzd 0GEN7 '' AttO;�T FQjLIlV.cPBL"TIeN For: Fill All information must be My aempleted prior to any Trenches inspections beicS made. PCHD Coutmetlon Permit # P 5'3 - Of �y Located: + e,%a Dr , e. (T) /da /J W rr 0!h Owner/Applicant Name: h ' Ttl _..I a-. Block a- Lot,.7� formerly Sub"donNama: O'.N�s Subdivitlnn Lot # 1 Is system fill completed? _ yes' Date: is system complete? Date: Is system constructed as Per plus? Is wen druw? Date: Is well located as per plans? Are orosioa control measures in place? _._Yzedr I certify that the sydem(s) s' listen, at the above premises has been com acted and I have lnspeeted and vetifled their completion is accordance with the issued MM Construction Pem it and approved plans and the Standards, Rules and Regulaions of the Putnam County Department of Health. Date °1 -L 2-00 Certi9d by: �RA t, ' De ' rofeissinad Address: ;10" me- 17-7 Li c. # S l2 - v A -t L f 7 9' b f PUTNAM COUNTY DEPARTMENT OF HEALTS DIVISION OF ENVIRONM NTAL HEALTH SERVICES ATTENTION ❑'ADAM GENE J=MST FQA MNAL 2jSP TION For: Fill All intbrtnation am be Nally =pletcd prior to any Trenches inspec dow being made. PCHD Comtruetlon Permit # S ` 73 Located: 4 (T) a /l ark 0 Owner /Applicant Nami R. ' Tif __ 1 �,L._ Ri ek — Lot �_ Formerly: Subdivision Name: 0 Subdivision Lot # _ & Is System fill completed? Ditto: is system complete? _ Date: 1s system constructed as per plaits? Is well drilled? Date: Is well located as per plant? Are erosion control measures in place? w_Uto I ce* that the system(sl as listed. at the above premises Iota been constructed and I bane inspected and verified their oompled(m in accordance with the issued PCUD Construction Permit and approved plans and the Standards, Rules and Regulations of the Pub= Cetmty Department of ZA Date: 10 0 o Certified by: PE ,� RA DCO& Professional E Address: 11 ?�., lr � /-A ,".....– Lic. 0 Form M-99 P.01 0 V1 m l I l )5yT5 ' I I 1 1 1 _ 1 1 t 3 _ � N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # h ' _ •2c 00 Located at ' -Ili a `11.1;1 pt2-1V Town or Village pAI7-E DH Subdivision name 01 HAP-A Subd. Lot # i4 Tax Map Block �- Lot T Date Subdivision Approved '� U I % Renewal Revision Owner /Applicant Name b- a •W - C,0H i P-� L� ( nN Date of Previous Approval Mailing Address P•Q J�©i( .4U PNTTF --ltir4 N i Zip �`� 4 Amount of Fee Enclosed NO F -5%4 d Building Type d ENI Lot Area 1 W No. of Bedrooms 4- Design Flow GPD Fill Section Only. Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 51 i LF- 1��6 Other Requirements: �• 0 ' To be constructed by D• •�` G0 �fWJvT►►�►�+ Address F. Q ' k tk)Y, 4U VMIL*50 P�Y? G41 � Water Supply: Public Supply From Address or: 'A . Private Supply Drilled by Ti) :o : Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date I-rq 01) Address 6-J M M6 ? 6.-050 K License # 15 G 11-4 L W i -r--n APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or difipe2 w n nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires am: ew ' . p proved discharge of domestic sanitary sewage only. By: Title —j Ip'�/ �-- Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner n,E,V+ C0N51 per. C-T1©H Address P, 0: SOX, -.,gyp PP'tJg�L64d tJI 1153 Located at (Street) P%45 yi ew D9_Avr 0%c I EK, Tax Map f 1. Block Lot (indicate nearest cross street) Municipality PAITeg-A50N Watershed iFA(6T bp_1 64i Form DD -97 SOIL PERCOLATION TEST DATA ( 1N �W, J516U�G,\) Date of Pre - soaking situ o Date of Percolation Test 8I %1 J oo .Dept o a e at r Mme lla se Time : rom Ground Surface :(Itches: Level prom In Percolation ; Rate M�n/Inch Hole N IBM. Start :Stop es ; 4,9/1 3 4 5 1040 11 6 9 3 2 I94A - J °'� ►2 .0 3 41► 3 4 5.; . t r"�Al 3 N �< .p ` 4 IS, No. 66124 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 AA, na,WMARll�frOFMBALTR OF, Mq c 7' AW 77- N� 7-7 77 :5 —.4 7� t '7 �'71, AM A W ,x-4 Y - 47 4P �4- -e AMP V, , t 'A' subttovout tm atlOro i6iW6i]4h'fjA 661►wte0 44166- i"I Ii6"ftnft,wlth t kk4eiompwiw**! 'pliti!W ol,Construetlai rylili "t iMntifM to tM p A now Ift "to Sim, - ip1 W 9! vq w above, --ov the,, N, "64MOR71 "101iiiii -04- ce IMOVII, -e .-DOW AA-� PAL Y, ?; L file, No on a Ap'"Oveo. W hVdAt elionp -4 Y. am fo Itiev. Y1. S pip ul to tt rn O "Y4 to N3 ti -- >0 Ip BEDROOM �•�i ►iii �`! ►`t►� • • . ►`�•f ►••�1 ►`�•i ►cif T. -MICHAEL ' 'P.E'.. BOX 1'i BEDROOM • • SIN&LE FAMILY r 24' SECOND FLOOR 1/8" = 1' —as -d51 MA5TER 512RM 24' -I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 01 Located at .s: c (T) T / -CT ��.� �� Block '. . ''... Lo Subdivision of �A A. Subdv. Lot # 4- Filed Map ; •'.:'�i �j(�p %Date ,. T. MICHAEL DAY, P.E. Gentlemen: CONSULTING ENGINEER a P. 0. BOX 243 This fetter is to authorize SHENnRACK N X inSSI te_.�- ar,.h; a duly licensed professional engineer •� or %g�� rP� . (Indicate to apply for a Construction Permit for a separate sewage system, to r a 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 neces4pa'ry papers on my behalf in connection with this matter and to supervise the construction of said system or systems in with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County ,ani- tary Code. Very truly yours, • ' ne d Countersign Owner of Property P.E., R.A. , Address T. MICHAEL DALY, P.E. Address Town P . 0. BOX 243 SHENOROCK, N. Y. 10587 7 -71 2_c'� Telephone Telephone PUT NAM C O UNT Y D E PARTMENT O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: ��LI 3. Locationk!fV /C:� 4. Project Engineer: 5. Address:�'?��� Z4?� License Number: 4 4w Phone:` -DSD- 6. Tyoe of Project: Private /Residential Food Service Commercial , Apartments Institutional Mobile Home.' Park d. Office Building Realty Subdivision Other (specifll)•4 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental. Impact Statement (DEIS)' required? ............. 1�)A 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.; . orother officials, ordinances? _ ......................................... �-P-Q -JET" 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 Discharge. 1> ygf Surface Water Ground..Waters 15. If surface water discharge, what is the stream class designation ?........ _ 16.'Waters index number*(surface) ........... ............................... 7. Is project located near a public water supply system? .................. 8. 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) .......... (o .................... W 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required?..� 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland ?...... .......................... ............................... 28. Wetland ID Number ....................................................... 29. Is Wetland Permit required? ............................................. Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... b 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or.other crops, solid or hazardous waste disposal, +, 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 dispd3sal site or any other potential known source of contamination? .......•. YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? .....:;i... b �•� 34. Are community water, sewer facilities planned to be developed within 15 years.) 35. Are any sewage disposal areas in excess of 15% slope ?'..................... '.'... �! .a:7 ...� :.. .: . 36. Tax Map ID Number ..................... ... ..13� 37. Approved Plans are to be returned to: .................. Applicant f"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. I hereby affirm; under penalty of perjury, that Information provided -on this form is true to the best of my knowledge and belief. false statements made herein are punishable as a Class A Misdemeanor pursuant o Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: -z,_4 O-zaLt�- . \ , DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Addreas i °'" l Ajo Viliage/City Tax Grid Number \-=b WELL OWNER Xame Mailing Address ivate O Public USE OF WELL 1 primary - secondary M4tfSIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT !" gpm /# 13 REPLACE EXISTING SUPPLY a-ldw PLY EW DWELLING ) PEOPLE SERVED_(f_/EST. OF DAILY'USAGE� gal ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE 19tRILLED DRIVEN CIDUG C]GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES y NO IF WELL IS LOCATED,IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. MAajq —4T73JQ 14— WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES LINO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED —� © 119_T9;:� ' SEPARATE SHEET �eA (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 thirt?* (30) days of the completion of water well construction, the applicant shall: 1. Pump the welliuntil 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.man /ner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �rC�/ 19� Date of Expiration 19 g_-2 Permit Issuing Officia Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow,copy: Bldg. Insp. Orange copy: Well Driller 10141, w?mAA[ COuNn DzrAlAl M OF HSAI.TH DhIdesi d amboe®aetd Heath Sonde . Carmel, N.Y. 10612 Beamewupmo lda Fsdt / a C�[CATS OF COMFLLANCB own or Vubg* Tax Map_ Block Los Eaoewal._ ❑ Bevlden ❑ Dab d Frovkoe Approval Maftij Adioo 'f� Tows P JLJ 7Jp Z SZr� Date Subdivision ADRroved 7-4 192.- Fee Enclosed Z.O®r00 soft Ty" lYFe 7�r =_/ Lot Aeaal 5� lm Sct Od i j vdaa4k � 'r NoI d podmme `1 Dodge Fbw G P D Q PCHD No/ld sloe b BegoµAed Wbea Pm Is ooapkaad Sapaeate Sowera�o srgm a eo�rlae d� —GaHw Sopol: Task � N � �� • , �G� To be arle lead by Address Water Supply: Pak Stipple Frw Address :—� Sa Wiled bon yT� �� \'--r-7 -=/ i ! Acw -;.ri Au7 Lam- Oebsr -A:� t a %w — ---1 1 represent- that I am wholly and completely responsible for the design and location of the proposed system(s); 11 that thl separate sew di sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rpu ns o m County Department of MMlth, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of MMRhwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that said bulkier will peace in good operating condition any part of said sewage disposal system during the period of two ( s Immediately following thodato of the itau- ance of the app r0 1 of the Certificate of Construction Compliance of the Rorlqin�al Xsto"mn an y r s o; 2) that the drilled well described above well bolocated as shown on the approved plan and that laid well will be Inst 'it eta rulei and rqu YMnf of the Putnam County Depa nMnt #f Health. Oats _���� Signed P.E. 4-' RA. — Address 'lam License No C APPROVED FOR CONSTRUCTION: This approval expires two.years from the date issued unless construction o the building has been undertaken and is revocable for cause or may be lr , amended or modified when considered necessary by thereonaissioner of MMlth, ny change or alteration of construction require/s�a`na�ve it. /Approved for disposal Of domestic unitary sewage, and or water supply only. Rev. De gy l c' 10/88 Tarr u. it v M stfbdlelala. Naebe IPUIWAM COMU T DSFAHN=f OF HEALTH amdondawbownsimild Bod& Sarvlooa. Caemsl. N.Y. 10312 HN&OW a Pnvldo For" / FDIC SHWA= DEPOSAL SYSM Let Owune/AppRaa t Naar I' o ae CKRIBI LATE OF CONNUANCB P - i 'P•—�5 3 -- Tmm ar VRalse Tea Map Blak0. W Remawd_rl3 — RawWeo ❑ Dabd.ftT*asA..dvd J0(Zi +, Tom zb I`Z- ,SoL-L see Enclosed ❑ Amnssnt- r i{L T�/�L� Am (� Z��� Fetdbsi Naoabae d He�towto T _ � � � —v '�'G Dodge Flow G P D S%Mab Sew mo Srtwt to eassdat d GeiOw Sep* Trek said To be oo�atraebd 07 �� ' '' ♦.s l...e. Water SW*: P*& SW* Film Addrw an `--� teSappbr Dl1Bod �f '� / 4d&e - �t Odm Reaaboussaa 5 i .©TJ � , / �ic• �t'7i� C 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sews • die out s Item above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules an rpu a sons o e nam County Department of Health, and that on completion thereof a "Certificate, of Construction Compliance" satisfactory to the Commissioner of NMRhwill be atbmRted to the Department, and a written guarantee will be furnished the owner, his successors. heirs or assigns by the bulkier , that said bulkier will place in good operating condition any part of said sewage disposal system during the period of two (2) years I lately following thedate of the Issu- ante of the approval of the Certificate of Construction Compliance of the original sy or any repairs t o; ) t the drilled well described above wNl be located as Mown on ths�approvsd plan and that mid well will be Install p4h wi the eta ► nd rpu ifgn of the Putnam County Department f(]Health. Oats fa I . -1 r ; n R. . `�R.A. — Address t.iesnse N APPROVED FOR CONSTRUCTION: This approval expires two years from the data issued unless constructio of the building .has been undertaken and Is revocable for cause or may be amended of modified when considered necessary p the Commissioner of Mss h. Any charge or alteration Of construction nquiree a nave W ,_ it.� �Appr/ov2e�d for disposal of domestic unitary swvege, and/ n er su Rev . Oats / %� OPIy only. 10/88 '-7' sy �-� 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 3 WELL LOCATION Street dress To Village City wn Tax Grid Number WELL OWNER N e Mailing _OCV Addr 7, J /� 0Pfivate O Public E OF WELL 1 - primary . - secondary G41ESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT• gpm /# 'O REPLACE EXISTING SUPPLY � EEW S LY NEW DWELLING PEOPLE SERVED /EST. O TEST/ OBSERVATION O DEEPEN EXISTING WELL OF DAILY USAGE _C Bal 13-ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE [3DRf LLED DRIVEN DDUG O GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES " NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: o kj:/ c`'__ Lot No. 4 WATER WELL CONTRACTOR: N ;!> Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L+ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 1-toW SEPARATE SHEET to (date) (signature PERMIT TO CONSTRUCT A WATER WELL This ?ermit 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 thirt7 (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. Dur:Lq all well drilling operations, the applicant shall take appropriate action to assure that any ad 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 contamin t e surface or groundwater. Dat a of Issue: Z'' 19 �. Dat eof Expiration 19 Permit Issuing Official Pe rm` is Non - Transferrable White copy: HD File Pink copy: Owner 3/a9 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # e Location: Street Address: To 'Village Tax Grid # ,,� Sc�ni Map Block Lot(s) Well Owner: Name: Address: j2 Z- f1, AA-0 0 /75 � = /\I –) IL —D 6,k4 Use of Well: esidential Public Supply Air /Cond/Heat Pump Imgation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served B Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason }>• for Drilling Well Type. _L,,,,-Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No G--- ----' Is well located in a realty subdivision? ...................................... ............................... Yes 4-- No Name of subdivision U' 14A C� K -S-t3 F�,pl ►1; S i cn.l Lot No. Water Well Contractor: j2,; Address: Is Public Water Supply available to site? .................................. ............................... Yes No L� Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed we I location & sources of contamination to be provided on separ to shee Ian. .r Date: ?� Applicant Signature: 7 PERMIT TO CONSTRUCT A ATER WELL / This permit to construct one water well as set forth above, is granted under provxs ns of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State anitary Code and provided that within thirty (30) days of the completion of water well construction, the allplicant or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat driller cert' ied by Putnam County. Date of Issue Permit Is Offici Date of Expiration J _- ' Title: Permit is Non- Transferr ble White copy - HD file; 'Yellow copy- Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �l L DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 '74-1 914 278 --1 BRUCE R. FOLEY Acting Public Health Director Sean Daly ) - 3o Fax (914) 278 - 7921 'November 5. 1997 Box 243 Shenorock, New York 10587 Re: Proposed SSDS: O'Hara Lot 14 (T) Patterson Dear Mr. Dale: 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: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Engineer is authorization has not be' signed bv_ the properly -owner---, ✓ 2) Trench cover is to be noted as ,/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. �4 Plan has not been signed and sealed by the design engineer. emove or cross out fill settlement note. This is not applicable for fill sections 2 feet or less. ? 6) Add fill specifications, i.e., the °% allowed to pass a 100 and 200 sieve. "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10,, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." Upon receipt of a submission, revised to reflect the above, this application will be considered rill Very truly yours, �h Robert Morris, P. E. t, 4 vre J Public Health Engineer watershed /.- f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Z Re: Property of L Located at .�av�� //i�w ✓/= (T ) � S�J - &ertion 15 Block Z. Lot -77 Subdivision of Subdv.''Lot # I7 Filed Map # Date Gentlemen: C This letter is to authorize :�o5y -pk a duly licensed professional engineer or (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 with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours Signed Countersigned: i Owne P,,of Property P.E. , R.A. , #/ Address A'11 �%�lC°S' /'" %• /237 Address Town 45c A/ os�3-7 77 1 74 S-7 elephone !i)� 0 Y- V� 575- Telephone 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 NY 10587 Re: Proposed SSDS: Macaluso Ridge View Drive, Lot # 14 (T) Patterson, TM# 13 -2 -77 Dear Mr. Daly: May 8, 1998 BRUCE R. FOLEY Public Health Director 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: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1 1) Fill plans are required for all fill sections greater than 2 feet. 2) Trench detail is incorrect. 3) Current codes requires that fill be placed in the expansion area. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Ve truly yours, XOW Robert Morris, P. E. Public Health Engineer I uii�1 ILEAL111 SMVICES Z DESIGN UAIA SHEbr-SUBSUFACE SUIAGE DISPOSAL SYSTEM FILE W. (Mier PETER 0 1 HARA liddress P.O. BOX 282, PATTERSON, NY Located at (Street) ROUTE 3111CROSS ROAD sec. 1 o Block 2 Lot 11 ( dIcate- nearest cross street) ihmicipaliLy PATTERSON Watershed -CROTON SOIL PERMLATION 'I= DATA RBQLMM TO BC SUBMIM %M11 APPLIMIMS Date of"Pre-Soaking 9/07/88 Date of Percolation Test 9/08/88 HOW PIMCOLMY11 Itun, Elapse Depth to Water -fiam ___4k_Lta_r leved. 110. Time Ground Surface In Inches Soil Rate Start Stop Min. Start stop Drop In 11in/11i Drop Inches Inches Inches 1 )_-.I 3:28-3:58 30 24 .27 3 10 2 3:58-4:28 30 24 25.75 1.75 17.14 3 4:28-4:58 30 24 25.75 1.75 17.14 4 2) 1 3:1340-3:46 16 24 27 3 6 2 3:48-4:06 18 24 27 3 6 3 4:06-4:24 18 24 '27 3 6 4 2 1': 4o;i7n:7 ssic" 4 �j_ WAI IAA Jail �Wm �� \� 0 40 4 its #I, 0 f:7, Lms: 1. Tests tv be repeated' at same depth until, approximately eTual mil rates are obtained .at each percolation test hole. All data to' be subdUbd for review. 2. Depth measurcm-ii'Ln to be m3& from top of Bole. rev. 9/05 A i )i:a >il l c.. L. 611 12" 113 24" 30" 36" It 2" Ii 811 54" 60" 66" 72" 78" 8411 W HNHA SUBDIVISION '1'1:51' 111'r DIY A ItUJU1.1tW '11) 13L•' SUf34J.'1.1'I:L 141111 AUL1(.?1rlull SECTION 2 HOW W. 14A TOPSOIL BROWN i SANDY LOAM SAND I_(LIMEST0 ROCK ,Q 4.5 FT. I IOLC UU. 14B TOPSOIL SAND (LIMESTONE) 311DICATE LEVEL AT WHI 31 (ROLAZD+ h= IS ENOOUN7EI�D MULE Ili. 14C le TOPSOIL BROWN SANDY LOAM 7.5' DEPTH None leNIC11TE LEVEL TV WHICfi i+ im LEVEL MBEs AF'T7ER BEING N/A ' VEEP 110LE ODSERVATICtS MADE BY: J.F. EBERLE DATE: 9/6188____ n Soil hate Used 16 Min/1" Drop: S.D. Usable Area Provided 110. of Dedroc, 4 Septic Tank Opacity 42ae gals. Type Absorption Area Provided By 571 L.E. x 24" width trends s,r , Wier , Alt. Design Ham BAUM & ,CORNELIUSI P.C. Signaturt3'� Address -RD 5 d Route 22 SCAL • ,• Brewster. 'N ry York 10502 New r.rr r..rr ■ . ��...qr r...w 1 r ... r�a1} 11.11 Q. Tuts SPACC EUR USC BY 1113 Ull DcPA[r MWr MY: 4, y�i Op , off 1..30• �•s� Soil Date tffroved sq.ft/gal. Cbeckdd by Bate 4