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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -79 BOX 5 116 r *ti i 00175 PiJ1'NA1bI COUN'T'Y DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD. CONSTRUCTION PERMIT # �- 3S Located at --r-, I���� Z,6,x& l De i V6 (!o or Village Owner /Applicant Name % 9ys °),e?,, Tax Map 13 Block Lot I Formerl Subdivision Name i i�A�/4 Mailing Address Subd. Lot # 1� ,v4i;y. Zip /0-5Zc) Date Construction Permit Issued by PCHD /� �/� y,qi✓ Separate Sewerage System built by A%! Avizl) �il'P Address /�, �I�LF -�"� /�% / ' Consisting of l50 Gallon Septic Tank and Z /y zy Other Requirements: Water Supply: Public Supply From or: Private Supply Drilled by Address Address Building Type S/ P, /5WR Z - Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? A4& 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 an zz s ds, rules and regulations of the Putnam County D of Health. Date: Certi fied by P.E. R.A. Address # 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 approvalTo� ubject to modification or change when, in the judgment of the Public Health Director, such revocatio ific atio change is necessary. B � Title: Y• late: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNi4Afl COUN`rlf 6i�ALT9°! DEPT 4r T ter'° !w 'rte c z . ,., 4 .,;� !• 2 f 2-�,y, Y , h4 Geneva Road' (914),278 -6130 w Nz 0 ©E�' v sz igri —i er,�NY 1o509 ,NRecei�ed of 't..r.. - K r The Sum Of 1 j�' Dollars �I <: x THANK YOU ►,T�s�{� � �-❑ Caas� . � �YChec����M �D� � di�� r _»� YBy'3 �r , ,rte' �J �, � ����,' r � �sj�r' ^y k 1 I COVER SHEET PROJECT (Owners Name)- k,-,, STREET: 3, SUBDIVISION LOT #* ti M[JNICIPALITY: TAX MAP NUMBER: DESIGN PROFESSIONAL: JQ,� DATE: 91c� 8h,v, REVISION REQUESTED ADDITIONAL INFORMATION OTHER YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y, 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.905982B CLIENT Q 77604 NON STAT PROC PAGE I E.T.K. BUILDING DATE/TIME TAKEN: 09/22/99 09:00A 215 VAIL LANE DATE/TIME REC'D: 09/22/99 10:00A NORTH SALEM, NY .10560 REPORT DATE: 09/24/99 PHONE: SAMPLING SITE: LOT #16 RIDGEVIEW DRIVE SAMPLE TYPE..: POTABLE : TOWN OF PATTERSON, NY ARESERVATNES: NONE COL'D BY: EUGENE KEGICKE TEMPERATURE..: NOTES...: WELL TANK COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 09/22/99 IRON (Fe) 0.201 MG/L 0-0.3 mg/l 2037 09/22/99 MANGANESE (Mn) 0.018 MG/L 0-0.3 mg/l 2037 C TS: ' Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERYICES _ 321 Kear Gt�eet ` ` Yor�town Heights, N.Y. 1059G �^ (914) 245-�800 . All t�ert H. Padovani, Dire�tor � LAB #: 3��. �82B CLIENT #: 77804 ' C~~~~~~~~~PAGE~~~~1 ~~~~~~~~NON~STAT~PR0 E T K B�IL�ING 09/22/99 09:00A 215 YAIL LANE '' D ATE/T TM� REC'D: 09/22/99 10:00A NORTH 5ALEM. p-,! `10560 �EP�RT DATE: 09/�4/99 | PHONE: SAMPLING �IlE� #1���— VIEW DRIVE S "PE.': PO7A9LE � x 0 8F PATTERS8N, NY PRESERVATI'ES: NONE - COL'D BY: EUGE�1E �(�SI��� TEMPERATURE x WELL TA / ~~~~ ' ^^ COLIFORM METH: N/A DATE FL��-PRQCEDURE RESULT NORNAL - RANGE METHOD - ~~� 09/22/�9 IRON (Fe) ` " 3 7 ~ �~ c� 09/22/p9 MANGANEGE (Mn) � COMMEN��: Fe/Mn If ' ��th iron �n are present� their total va�re '` `` combjned ' �c�cz Z3: / -- � - �u '-� �1 ` \ ` . | � ` SUB^-ITTE[� BY: � ELAP# 103�3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: !7 Z. To n/Village: &ZSap) Tax Grid # Map 13 Block' Lot(s)%j Well Owner: Nam AAddress. rZ2 oN Use of Well: 1-prima 2- secondary Residential Public Sup Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion---..a Compressed air percussion Other (specify) Well Type Screened Open end casing--- Open hole in bedrock Other . Casing Details Total length -- ILft. Length below grade ft. Diameter _ in. Weight per foot alb /ft. Materials:., Steel _ Plastic _ Other Joints: _ Welded Threaded _ 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 _/O gpm Depth Data Measure from land surface- static (specify ft) V During yield test(ft) / S' Depth of completed well in feet 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 3 (o c 3 N If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity 7 Depth 140' Model Voltage 930 HP � Tank Type WC- tVx�Volume A- Date'W 11 Competed Putnam County Certi ication No. Date of Report Well Pffiller y ignature) iNu i r.: rxact Location of weir wttn distances to at least two permanentgandrAarks to be provi ed on a separate sheet/plan. Well Driller's me lord,,-S11 G Address: N /V. Signature: Date: j (� White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ~ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, 'Director LAB #: 33 ?08160 CLIENT #: 114 NON STAT PROC PAGE 1 ~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TORLISH & SONS DATE/TIME TAKEN: 08/19/99 12:00P BOX 271, 45 MAPLE AVE. DATE/TIME REC`D: 08/19/99 02:10P ATTENTION: DWAYNE TORLISH REPORT DATE: � 09/02/99 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLINGSITE: GENE KESICKI LOT 16 : RIDGEWOOD RD. COL'D BY: THOMAS TORLISH NOTES...e WATER TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE,.: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF -------------------------------� RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/19/99 MF A. COLIFORM PRESNT' /100 ML ABSENT 1008 08/19/99 LEAD (IMS) 1.2 ppb 0-15 ppb 9101 08/19/99 NITRATE NITROG <0.2 MG/L 0 - 10 9139 0809/99 NITRITE NITROG <0.01 MG/L N/A 9146 08/19199 IRON (Fe) 0.303 MG/L 0-0.3 mg/l 2037 08/19/99 MANGANESE (Mn) 0.4045 MG/L 0-0.3 mg/1 2037 08/19/99 ` SODIUM (Na) 2.51 MG/L N/A 08/19/99 pH 7.8 UNITS 6.5-8.5 9043 08/19/99 HARDNESSvTOTAL 103 MG/L N/A 08/19/99 ALKALINITY (AS 99.0 MG/L N/A 08/19/99 TURBIDITY (TUR 2.0 NTU 0-5 NTU 08/19/99 MFT. COLIFORM PRESNT /100 ML ABSENT 1008 08/19/99 E. COLI (CONFI ABSENT 100/ML ABSENT COMMENTS: ' BACT THESE RESULTS INDICATE THAT THE WATER (WAS),(WAS NO!) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & oCopper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb' and a COPPER value of 1.3 mg/L, else water treatment must be underkaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits fpr Sodium are proscribed. Suggested guidelines state that for pe ple on a sodium restricted diet,the water should co'tain no Ore than.20 mg/L of Sodium. For those on a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM o 4 1=d I - Owner or Purchaser of Budding ee Building Constructed by Tax Map Block Lot �A I14°r5�� Town/Village 3S �K1Gi��VI�'w ^ld SJCVU1,eLj �S1'A1'i�S Location - Street Subdivision Name L, 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. Dated: Monthsv Day Z0 Year 9 --1— Gene`rat Contractor (Owner) - Signature Corporation Name (if c oratio ) Address: 2 �, ,' �c, v,E!- State N S ct lP" h% / Zip t 0 5V(0 0 Signature: Title: �u-o Corporation Name (if corporation) Address: State Zip — Form GS -97 3t 4 gitpr 57:3 j`drr 9 I ' _ v 4 IJ 1 F M,n L rr P rt'rsj'�?` t 7f ,�'�'� it•.X yrl 1 ' " �^ F a ° is id• +.. {Cr"`�+� i t # ,a,I Si r t ' t t 3 " ° f + S =i ti ,7 's. pit r .,� �{tr{z / j' .rx' F t# _ / 1 �y ♦ .. s F ! � � fl�� �. ; ". -1m ax �` �..� F�.i' R+y. ��� '. +13�i� vr1 �• ��'ti. b '�" "i` v`i �� +z.' 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'rj > �r� ,�1 & r<a�. ,�� -•• +ETy �: Y�% t3��' ��T'i'$� �f` .����..k, ^,' �YF.�'LCi- i. � 4gh*p (F4R• �? ��;,� , I�' 'i��fi, j�F,�� : �S _r. t �ax _`iii 4�.y M` � {'"" ✓ 3 �'h t [ - ie' y:.P;, ms _xl" ' ,� 'r' ' °,Rp•�n, .iyJ: a 1 �i�r , a.t t t � y �: dro 3* u z �..r. • � r� f,r" F,�.1:?' i"r� r ". Y� ,�� 'S. � � r` i it � %*F Ir�sY: r . 1 2'_ —2, _777 7 77M77! - XYI� 1 couitIq'i' I� ? ` ` Dlehit� •[ Di�!•a�sdl.Hat>h6 Senloer; CbasteY. NY OF SEALTH ii mm A F UANq W. 7 'e" 11lo ` Daft ofi �� 0 al 7116 Towel Adder _ U AmA, Fee, Eiiib16'S'ed n Datt SbdlVi�id�'�AtArbvea 0i i0kill -Mmuft, Tmie an:02hm IM Am FM 4 Dei 0* ae tlfohafr a[ Hatwar 4' - b 8 6' w'lp F�ow G P. — FM NoMidai IsRecisibW Wh,6 Tela eigi 0'(0 q Lj Fmr-j� 1 anism Qi Adifrimmi Wart Ad&Vn' Swk: _T 6y Odmir he ds�Sig n f j proposed Syst . . . te 1) 'that the potato ispoul skeni - on P., he is shi on the a Moved amendment there to &IW�,inaccortliric•"ivith.ihi. standards, rums PF!R r"Via!oolls o • Ing !�!I,nafn t; eon0itbn . ietely folilim,14 tfiedits if the 12i t thit tells dr4lied i�iii"iesi�r 81104illit is" if Imst a w I he wo, on thiii iihat aid well wilube I i ce 4 �ind rime-UMFIR—Sof tells Pults'ari I be.eci !'� , - " Coulty,"rtwpm'of kii bat, I P E A A 7" S I-S', _4 7 Ucens No ApPR0TqjfFOP,,;O"STR, TIQP i4voCable f6i Cilua or ` 14 , , _MW sqlIft requires a now it. Approw•icl Rev. 10/88 if approwatl expires, two Years, const ctio of the building has be undertaken and is ,pnil,ithe clateAssui unless i9•i wMWicioiislds►•d riecesiiiy' isSioner 0 14484h. Any citing* or'siteration of constiuctlin by'• oTn v sin- d/QLWIw8te water supply only. a" . I ;ie ------------- Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location R /T_k�,,E VIC— W DR TownT- iZSa�c/ TM-0 13 -9, — 72 1. S ewaae Svstem Area a_ STS area located as per approved plans ........................... b. Fill section -'date of placement 3:1 barrier Lath. 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, 250... ....other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches I . Len required Length installed 2. Distance to watercourse measured--�-,9_c9.Ft .......... 3. Installed according to plan ......... ............................... 4. o ench acc ' lbj- 1/32' foot ............. 5. f roperty Vne .- foundations.......... 6. Depth of trench <30 inches fro su a ................. 7. all Fd r e sio , 1 0° o ... ..... ............. 8. g - " di eter l 9. o r rep h 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pum2 or Dosed Systems 1. ize o pump c am Ter ................ ............................... 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........... IT House/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IN Well a. Well located as per approved plans . ............................... b. Distance from STS area measured + 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 watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 Date:. $ 2 ?9 Inspected y: -Z Owner 49 WA ZZA Permit # P — 6-41 — 673 Subdivision Lot # /,6" / a "1 /rT ` t i i i ,1 iVii�� Putnam County.Department of Health Diviei-on.of Environmental Health Se2-71008 Approved as noted for conformance with. ap i1c hlo Rules and 12egulations of they lam Coun .y Healtu Degartme I �1 \ s ±,nature Bc Title ate • � . }Z_q g, f ! 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Kf -. .n _ .+w t;r?^:r � _.... t.I, x.c ,.. a T: .....- ,..LS,'^:i:� M P sa y� lyM ' �.�: fj.M11i bdtlit a.s.�ue'11n ldMtab , ptri`bjry ropetant t� Mt�lt wholly n1d eAmtMibh! - WntwY fOi tM daM a00ri dawMlad will,tja oaittiuetad �raliown on °•tM a /ptowd Mon �,Orwrty pipartawanf �of t�Rh, andaliet on'eomONtiowaMreof'a - M,swrnNtN to tMrOa/Mfi�Nit. �a wrNtdn Nrarara»a w1U�1 Nt�u M pN o/watM aMdltlew awy'/wt of -pY a�wa/a di1/ Mq a thjaNnwf M tMlCwtMkitd of Comtnreeari =Cowiptli ;�rNl N IOeatN at rinww Mi,at>N svi+ /lan iM that Y id, aK will CMMMY / aM ti u # �a� at R Oata � fit, t � Syn Afr/ItOVED� /OR �t:ONfTRUCT10Ns TINt a/�►ew1 air/irit fro"Mla for ;a +u tii awldndar er Wded"Isl w1YO'eon .._, NNrMaa a fi!►n� AM►oirad fOI. dKMW' of dory" ogee � ' Or Y !i 0 a ffmSufIM Otlb pp� �.� = —Vdmo G a -, pimn bm cation of tM popoMd iYfCamtga 1► tMt tM aws ta '.di YI 7svdwm Ma to anO.Y actoritanoi with tM staeMardtti',rult a ,rqu ib Of CoMtrudien ConiWUaa' utisf&t6o* to tWComIn'__' wr M'NYMh4i" ed tM owriw. his wcaporf, hale or iatl�ila t Y tM lwtlM► th�t''YId CIINrar wlK . ; gn`duiMi��tM aiod of two (t) ydMt h1111Y/MtHy fO110whq tMUti Of tfM iffy- •; . oa al/inal tyttinr�w any .; r thwitol2) itrit tli�'drHlad:wll daaorMd avow, M wKh rtU. ruMt aed iNuY�ns e_f tM : /utMrn y Lkanp fY :M Aat unNts construNbn of tM tiYtgb» lwt ba�n�,uridwtakiii and is ' �.y tl :. ComnHifienw o1 MYlth. ' Any drrNa of `,aKwdtlon of een�trlictlsn : to :watw t+io/b eg1Y ,. , ,,• .. , 1 NI I� OF $EAUR w 1E or OMQIJAlMZ Pik" 1 _ _ ,•� N> 3y iF 3 � � S`J �� F3 � � �./ ✓ l� ?awn I Fee ":Enclosed, amr,nr- :a ffmSufIM Otlb pp� �.� = —Vdmo G a -, pimn bm cation of tM popoMd iYfCamtga 1► tMt tM aws ta '.di YI 7svdwm Ma to anO.Y actoritanoi with tM staeMardtti',rult a ,rqu ib Of CoMtrudien ConiWUaa' utisf&t6o* to tWComIn'__' wr M'NYMh4i" ed tM owriw. his wcaporf, hale or iatl�ila t Y tM lwtlM► th�t''YId CIINrar wlK . ; gn`duiMi��tM aiod of two (t) ydMt h1111Y/MtHy fO110whq tMUti Of tfM iffy- •; . oa al/inal tyttinr�w any .; r thwitol2) itrit tli�'drHlad:wll daaorMd avow, M wKh rtU. ruMt aed iNuY�ns e_f tM : /utMrn y Lkanp fY :M Aat unNts construNbn of tM tiYtgb» lwt ba�n�,uridwtakiii and is ' �.y tl :. ComnHifienw o1 MYlth. ' Any drrNa of `,aKwdtlon of een�trlictlsn : to :watw t+io/b eg1Y ,. , ,,• .. , 1 �J PUTNAM COUNTY DEPARTMENT'OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at I4/� 13 Block '7. Lot Subdivision of Subdv. Lot # �Cl' Filed Map.# Date Gentlemen: This letter is to authorize ��9�✓ T�S�i°H l��,y a duly licensed professional engineer car rAg; Pr P- ar .hi t (Indicate to apply for a Construction Permit for a separate sewage system, to the above noted property in accordance with the standards, or regulations as promulagated by the Commissioner of the Putnam County Department of Health, sign all necessary papers connection with this matter and to supervise construction of said system or systems in conformity with the provisions of Article Education Law, the Public Health Law, tary Code. Countersigned: '! i P.E. , R.A. , # 2 Address 4i - 776 -- S-77,�> Tel'ephone the Putnam County Sani- Very truly yours Signed -2 Owner Property Address Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services . 4 . Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 18, 1998 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSTS: Macaluso Ridge View Drive, Lot #16 (T) Patterson, TM# 13 -2 -79 Dear Mr. Daly: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded 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) The minimum of two feet of fill is required over the entire SSTS. 2) Fill is to be shown extending 10 feet past the edge of the trench and then sloping 3:1 to grade. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. RM:to Ve ruly yours, Gov ROUO Robert Morris, P.E. Public Health Engineer LY oG c � _ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Sean Dah Box 243 Shenorock, New York 10587 Dear Mr. Dalv: BRUCE R. FOLEY Acting Public Health Director November 3. 1997 Re: Proposed SSDS: O'Hara Lot 16 (T) Patterson 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." r- _-t�,-►^ �) Engineer's authorization has not been igned by the property owner. �} Trench cover is to be noted as geotextile. ✓3) Erosion control measures are to be shown and detailed for the house well and SSDS. J Furthermore, a note is to be added stating all erosion control measures are to be installed. ✓4j Plan has not been signed and sealed by the design engineer. J,�) Remove or cross out t 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 further. Very truly yours, R/� I/j,// NOW60 Robert Morris, P. E. Public Health Engineer s Rlti,i/mh watershed ':Y 'x-' _ = �+'.�t`p,"�°';?? Z{nrri..°- t-"t°lp.s�:4.zzsi�.•^ ,�-5- *..... .s. - .'.. iOm ce`:in 0 at County Depait of Ith r p S bate, ' � t I �i� Mneoi " AAareu'�i w . El C se APPROVED FOR CONSTRUCTION This approv+,t expirei.two Years from the rwoea0le fer'favM:or,'inaY a "amended dr modifidd when Confidered n' sew a ".' requires a new it A00600' f0i'iisoi: of domestk sanit i R2V'. lww ate L 0 the oropo ed systems) 1).'tnat the separate sew di ial stem 11 n accordance with 'the standards, rules a regu n; or mm struetion.CornpiianCN ,satisfactory t01114 Commissioner of MMKhwill N► hie wcaaoi MMS or'•assigns,by, the builder,'thet said, 6ulkler will the period "of..two (2) yeMfa letNy`fcllowlnip tM'date'of. the issu- sY.. am or any irs that that the'drilled welt " d�e,scre" 860w With Ste r reoy i ni of.•the' Putnam P.E. License NO wed unless construction of,t building .has been undertaken and is ,Commissioner Of .Health. Any change Or alteration of construction 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 Street Ad ress -rte To Village City , Tax Grid Numbe �, , ��, - a -jq OWNER Name Mailing Addr U Oftivate O Public SE OF WELL 1 — primary - secondary , CI RMIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY OABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHTgpm /# 13 REPLACE. EXISTING SUPPLY SEW S PLY f(NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGE gal O TEST/ OBSERVATION ' Gl ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR. DRILLING DETAILED REASON FOR. DRILLING �c WELL TYPE ILLED DRIVEN DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES t_- ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -77 Tts Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES --PO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: � LOCATION SKETCH 6 SOURCES OF CONTAMINATION PROVIDED (,-. SEPARATE SHEET l (date) (signature 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 third, (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 P� em Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well SECTION 2 llZVISION UL' 1NV11lIJI44MI•I1L 111: will bu(V1tl5 DESIGII LATH SIIEEr- smsuETCE SEWAGE DISPOSAL SYSM4 FILE M. 01mier PETER O'_HARA Mdress P.O. BOX '282, f Pgt RSON, NY Located at (Street) -B O U T E 31 1 /CROSS ROAD • Sec. _ 10 Block 2 Lot 11 (indicate nearest cross s greet ) i1micipali ty PAT T E R S 0 N Watershed - C R 0 T 0 N SOIL PERCOLATION ZEST DATA ItDQ'UM ED TO BC supra m) WI u APPLICN1'1014S Date of 'Pre-Soaking 9/07/88 Date of Percolation Test 9/08/88 BOLE I)(2MM CLOCK THE PEROQLi11ZON PIM OLi►TICN . Run No. Start-Stop Elapse Time Mina Depth to Water Fran Ground Surface Start Stop Inches Inches Mater Level In Inches Drop In Inches Soil Rate ' t•lin /Li .Drop 1) 1 3:45 -4:03 `18 24 27 3 b 2 4:04 -4:25 21 24 27 .3 7 3 4:26 -4:47 21 24 27 3 :7 4 5 2) 13:02-3:32 30 24 25.5 1.5 20 2 3:32 -4:02 30 24 25.25 1:25 24 .3 4:02 -4:32 30 24 25.25 1.25 24 4 I lot t 1. Tests to be repeated' at same depth until, approximately equal soil rates are obtained at eacdl percolation test hole. All data to' be suimittbd for review. 2. Del,Ut measurenents to be nude fran top of hole. rev. 9/05 L9 O'HARA SUBDIVISION TIZ'1' 1'1'1' DIM 1tUJU1.ItW '1U BC GU11.11.'1'1'!•1.) 1.11111 At'rLlC:A*f1.CU(1 SECTION 2 DESQUI''110N O OOHS 1•OJNl' IUM IN '1'GST HOLES 1)1::t)llll IIOLC 140. 16A c;. L. 6" 12" 113" 24" 30" 36" 4211 14 8" 54" 60" 66 ". 72" n78" 134" TOPSOIL BROWN SANDY LOAM ROCKS 5 ft. HOLE N0. 16B TOPSOIL BROWN SANDY LOAM 110LC Dj . —16C BROWN "j SANDY LOAM ROCK 0 6.5 ft. 31 WICATE LEVEL AT WHICn G74UNDWA7.'I•R IS 1EIJOfJUN'iEEt» None 11-WICAIE LEVEE, M WHICii WATER LEVEL RUSES AF'L'F2t I BFJM 12100 N/A VEEP 110LE 00SERVATION9 MADE BY: J.F. E BE RLE DATE: 9/6/88 DESIGN Soil Itate Used 2.4 Wn/1" Drops S.D. Usa ble Area Provided 80 T�1Z_�•pvgv ,• }- 110. of nedroams 4 Septic T`attk Capacity gals. Mnorption Area Provided 13i 6 6 7 L.F. x 24" width trends ; Wier 2 ft. fill; alt. design or dosin .re i `l,�r�•, "' �� Mama BALDWIN & CORNELIUS, P.C. Signatur,� •. h3dress 22 SEAL= SEA a RD 5. Route -' • Riewster, New York 10509 111ILS SPACC WR USL BY IICAml DEPAR'uMI! OmYs ''•,,,, �f ..`' `' 'Soil hate Approved sq. fVgal. Checked by DaL•e - 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �r Date Re: Property of D 11� IN Located at �185 Al s1d� r. ��- tTx >►. t �_ 13 ��1 o c k, '� •�' Lot Subdivision of A Subdv.:Lot # rp Filed Map•# � j P5 ' ",. t. T. MICIAEL.Df LY, P.E. Gentlemen: CONSULTING" ENGINEER ' ".�. 0.'96X 243 < This letter is to authorize SHENPRi )('K,N_X 10587 a duly licensed professional engineer or registerp� ter^ �+ 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 Countersigned Owner of Property P.E., R.A., # `Z Address T. MICHAEL DALY, P.E. ��-�-} -C t- 0 Address Town P.0. BOX 243 SHENOROCK, N. Y. 10587 �7 _ -7 S Zc'j Telephone, Telephone'�— r G BATH DRE561N6 1.:. BATH Room O #i BDRM. . GL. HALL - - - - - - 25' -8" T. MICHAEL DALY,. P�.ER, . BOX 243 SHENOROCK, N.Y. 4 rl L, MASTER BDRM #2 BDRM #5 BDRM 4 BEDROOM':GOL' ONIAL 51 NGLE FAMILY RESIDENCE I/bit 11-01i 1 24 24' "..1 ,z A` Y DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL -1-1 PCHD PERMIT #��� WELL LOCATION Street dress o Village City Tax Grid Numbe& WELL OWNER e ,® Mailing Address /-� CWrivate O Public USE OF WELL 1 - primary - secondary G- R'6SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUM4 O FARM ❑ TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT ':5-- gpm /# 13 REPLACE EXISTING SUPPLY W SUPP Y NEW DWELLING PEOPLE SERVED ?�>) /EST. OF DAILY USAGE__gal ❑ TEST/ OBSERVATION GIADDITIONAL SUPPLY 13-DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE nDfILLED DRIVEN EIDUG DGRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES e----'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 'r',a 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 Q t ,� ON SEPARATE SHEET /A (date) (signature) 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 Department attached to this permit: 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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 ma n, as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: e 19 Date of Expiration 1— Permit Issuing Officia Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller sv � PUT NAM COUNTY DEPARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: I" A7 -reVG0& N,4; 1 Z ;'C� --s i I 2. Name of Project: till 3. Locatlon(tV /C: 1� . 4. Project Engineer: ��1_4�dvl� 5� Address: �yK Zy'� License Number: t� Phone: 6. type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Kome'Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State En.vironmenta.1 Qua1.T1y Review (SEAR)? Tvoe Status (Check One) Type L. Exempt- Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. CIA 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? ......... ............................... %►- P-Q,.�'J�[" E t 12. If so, have plans been submitted to such authorities? .................. n1 0 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System 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? .................. -6 18. If yes, name of water supply Distance to water supply "' 19. Is project site near a public sewage collection or disposal system ?..... >.0. Name of sewage system Distance to sewage system M. Date observed: 23. Name of Health Inspector: >.4. Project design flow (gallons per day') .......... t! �?C. ). 0 .................... 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 U wetland ?...... .............. .................. 28. Wetland ID Number ........ ......... ............................... . 29. Is Wetland Permit required? .......... .. . :.. .... ...... .... .......: .. Has application been made to Town or Local DEC Office ?•..._ ................. �a 30. Does project require a DEC.Stream Disturbance Permit.? 31. Is or was project site used for agricultural activity'i'nvolving applicat,io6 of pesticides to orchards or other crops, solid or hazardous waste dispgsa.l,' landfilling, sludge application or industrial activity? YES or 'NO 32. Is project located within 1,000 feet-6f ext6tenca of abandoned landfill, hazardous waste, site,. salt stockpile, landfill, sludge disposal site' or any other potential known source of contamination ?' ..............YES or NO 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? 35. Are any sewage disposal areas in excess of 15%,.slope? ........................ " 36. Tax Map ID Number ......................................... 2 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 gruunds 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. SIGNATURES4 OFFICIAL TITLES: MAILING ADDRESS: