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HomeMy WebLinkAbout0367DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -80 BOX 5 I ru I�yL I r Ir 00176 i l,yr PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE ENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at i D a� m L)� ! l�9 own r Village ,; So A Owner /Applicant Name hW i . Tax Map — /3 Block Z- Lot 0p Formerl 14dLAV -aSo=> Subdivision Name 0 / /7-4 9; d! W .S ;6: e- -W- � Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD Zip Separate Sewerage System built by DES,/ (�26257- Address V.20 Consisting of Gallon Septic Tank and 042® G-1AI. ;=T Other Requirements: i RAJ. S5 Water Suip Iv: Public Supply From Address ®r: <riva�te'Supply Drilled by 447ZO'i% IIIA-77- Address &V f Z -7,-3/ nrT!/�L Has erosion control been completed? 195 Building Type -4 Number of Bedrooms Has garbage grinder been installed? A/0 0 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 d a standards, rules and regulations of the Putnam County ent of Health. Date: 0 Certified by P. E. R.A. (De ' rofessional) Address %8 SjWWO1 License # ZZ 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 revocation, ication o ange is necessary. By: Title: Date: 0110 2, fl White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 F? PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: TownNillage: Tax Grid # Map 13 Block a Lot(s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary 1 Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length eft. Length below grade 6 ft. Diameter Tin. Weight per foot alb /ft. Materials:. Steel _ Plastic _ Other Joints: _ Welded hreaded _ Other Seal: _ Cement grout __S/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 X Compressed Air Hours Yield gpm Depth Data Measure from land surface-static �JSjpecifyf ft) ,. /C !� wi'YI During yield test(ft) Depth_ooff cogympleted jwelll 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 If yield was tested at different, depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type . Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed le- e;� Putnam County Certification No. Date of Report 7 Well Driller (signature) NOTE: Exact.location of well with distances to at least two permanent landmaf ks to be provided on a separaq sheetlplan. Well Driller'snnName A, jvl'�)kl f ft "a' Signature: ✓ ���- t,i f�7 Address:–/ )/ ' AYi 31/ k //e1(56}? , Date: Z' ;-L , f White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 -r, YML E�UrRONMENIAL SERVICES ��1 mear �treet Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director ' LAB #: 93*903035 CLIENT #: 3692 NON STAT PROC PAGE 1 DEW CONST~ INC. DATE/TIME TAKEN: 04/13/99 01:45P PO BOX 420 DATE/TIME REC'D: 04/13/99 02:15P PATTERSON, NY 12531 REPORT DATE: 04/24/99 PHONE: (914)-878-2015 SAMPLING SITE: LOT #17 RIDGE VIEW DR : P'TTERSON, NY COL'D BY:-WILLIAM FINNEY NOTES...: KIT TAP. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE , TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/13/99 LEAD (IMS) 1.1 ppb 0-15 ppb 9101 04/13/99 ' NITRATE NITROG 0.52 MG/L 0 - 10 9139 04/13/99 NITRITE NITROG <0.01 MG/L N/A 9146 04/13/99 IRON (Fe) 1.61 MG/L 0-013 mg/1 2037 04/13/99 . MANGANESE (Mn) 0.283 MG/L 0-0^3 Mg/1 2037 04/13/99 SODIUM (Na) 3.94 MG/L N/A � 04/13/99 OH 7.4 UNITS 6.5-8.5 9043 04/13199 HARDNESS,TOTAL 200 MG/L N/A 04/13/99 ALKALINITY (AS 174 MG/L N/A 04/13/99 TURBIDITY (TUR 30 NTU 0-5 NTU 04/21/99 MF T. COLIFORM ABSNT /100 ML ABSENT 1008 COMMENTS: Pb/Cu LEAD limits for public schools-are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppbjand a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potenti|al. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no More than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. 'P ;/j;� '~~ WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND ^ FIXTURES THE NORMAL RANGE OF pH IS 6 5 TO 8 5 ' 1 . . ~ . .�^``�.��`��'�`�� A11110 UND17 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.903035 CLIENT #: 3692 NON STAT PROC PAGE 2 DEW CONST. INC. DATE/TIME TAKEN: 04/13/99 01:45P PO BOX 420 DATE/TIME REC/D: 04/13/99 02:15P PATTERSON, NY 12531 REPORT DATE: 04/24/99 PHONE: (914)-876-2015 SAMPLING SITE: LOT #17 RIDGE VIEW DR : PATTERSON, N. COL/D BY: WILLIAM FINNEY ` NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALAUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER:.0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER:' | ^ 140-300 MG/L (1 grain/gallon = 17.2 MG/L) BACT THESE RESULTS INDICATE THAT THE WATER ( fj) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN8 THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. - SUBMITTED BY: ;VAIT Albeit H. Padovani, M.T.(ASCP) L.0e0� Dire�tOr /! � '.( �' ^ ' '' E�AP# 10323 _ � _ _ yML EN�IRONMENTAL SERVICES S�l near a �ree� Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.903120 CLIENT #^ 3692 NON STAT PROC PASE 1 DEW CONST. INC~ DATE/TIME TAKEN: 04/21/99 10:15 PO BOX 420 � DATE/TIME REC'D: 04/21/99 11:55 PATTERSON, NY 12531 REPORT DATE: 04/23/99 PHONE: (914)-878-2015 SAMPLING SITE: RIDGE VIEW RD SAMPLE TYPE..: POTABLE : PATZERSON, NY ' ' PRESERVATIVES: NONE COL'D BY: MR FINNEY TEMPERATURE..: < 4C NOTES..": KIT TAP C .IF(.'JRM METH: MF DATE FLAGIPROCEDURE RESULT NORMAL - RANGE METHOD 04/21/99 MF T. COLIFORM ABSENT 1100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINu ��T—THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED By: Albe- Dire� � adovani, M.T.(ASCP) ELAP# 10323 i -s. 0 w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building cnAJ �;, C Building Constructed by Location - Street J'DEATnA__ Building Type 13 . . -Z, F0 Tax Map Block Lot ,_ alta-E— �c - . Tow illage Subdivision Name 4. ("T 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 guaranteelo the owner, his successors, heirs or assigns, to place in good operating condition any part of said 'system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive. the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month . Day D Year Si ature: Vwa� - _Re_�n Title: General Contractor (Owner) - Signature � mss► P_.�xztoe� �N L - '1.�iE�.a6 ( �'YIySTJee.�Cil c�n� - - Corporation Name (if corporation) Corporation Name (if corporation) Address: 7�c State Zip lZ1 Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser-of Building cS�CKJ Building Constructed by - E1-)6F"Wr,-Aj Location - Street ' Building Type �3 , O� Tax Map Block Lot (jo qNillage 0, 0 .TL Subdivision Name -4- f"-v . 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...yea�rs....... immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system., The undersigned 'further agrees to accept as conclusive, the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: ,Month s Day 1 o Year Signature: . Title: General Contractor (Owner) Signature �r l US► elX�lorJ =,Tc_ • E=: ,,g ��12e M OA/ Corporation Name (if corporation) Corporation Name (if corporation) Address: 0 �C, �{ zo State N Zip IZ5 3[ Address: State Zip Form GS -97 1250 s Mx� MA5C 5EGTION THRU FILL PAD 5EPT ,I TANK NTS SC, y - i 500 LOT "" �i, Hate •� �yr � x '' `'` � ,6 �j / /'' w / /•����.�� /n'��y /�' L� ' is`3 -r13'" � *° �'�``r'� m'`�-+, }�"•"�, t+';��k s� "3ti6 �: �t�,.t�r'+�isat . v�;�iz�•'�•1+"t / //. f /��/ e a~a�" rk�.`'fi�' '�� .ry � �°1� �� ...�k. i�.° + V ° � ,• "ia Y`.,yb> { /!!,"�k`y�'' F���y "{�'°`t� :,,,,t /�"�4a, / I � 4 b�. � �(��"�X`�rMy M`�•c � �" SIPHON G 51 PH V.H 50 G M NR to / /i ' // k 5EPT1 �\ 411 01 1/4 °/FT e /i OUSE': 5.16 LAY4 " ,,___- : i �, -'" ",_, � �•� LINE; � s" NOTE: IHOFRMATI ' FINAL 5UBl OF.00ARA K M, 1 5ECT16N 2 �IOOr�6 r-Y.P TI Syr >: rn 214.29' ' R :254 ALE III _ 20' r; L 30."f b } Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL a please print or type PCHD Permit # ✓ Well Location: Street Addr s : o illage Tax Grid # Mapf 3 Block L, Lot(s)90 Well Owner: Name: / Address: Use of Well: ' ential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 5 Est. of Daily Usag gal. Reason for FWace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes_ Ng Is well located in a realty subdivision? Yes No ...................................... ............................... Name of subdivision ln� a Lot No. % Water Well Contractor: -rte,, 7, Address: Is Public Water Supply available to site? .................................. ............................... Yes No v Name of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed wel • to tion & sources of contamination to be provided n sep a et/ lan. Date: Z 8 Applicant Signature: a /V - PERMIT TO CONSTRUCT A WAT;eer LL This permit to construct one water well as set forth above, is granted pro visions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New ork State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant 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 water 11 driller certified by Putnam County. a Date of Issue Permit Issu' QpfIcial Date of Expiration/ Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 FINAL INSPECTION LOG 1p 5t I DATE DATE REINSPECTION DATE PROJECT ADDRESS REQUESTED INSPECTED REQUIRED COMPLETED COMMENTS GYOSb�� �4 1!( Ef7v cIn Croce py Q, l��2'{f�$ N�2�ff�8 AlO TkC 1;idr Tr�s7'- Gon/tec¢!on 3c t5 �n.he / 1(%,23f 98 102S/p8 e5. 't rint �sttl� � = goX Lo-l� 36 Garm rV_Y, ta��2 T;' cs trsotdon'T. 4 Suxtvt G: Qa►? Lua2.`37 lonvi //� 12�Q i �'2 Sl9 I /3ol�j 1 ` e'� ?dck �j1 �yStPm Yl o bd` a h`c�/ zd Pa -!%e soh, W V, /2X63 / et over% 71 <ce +cr �kerCvoocQ !•fill ,jd, f �(�3n`y$ A,10 )V.'1, h �a i co 1(�2 5 98 l 8 -5 ye �/ oj99 Neea?S 5: /t ��•,�� �; - �wney�_ l�a`tfeySon, N 11� 6 3 .,� • cda e d cro�5by e�e�. br�rooe» aov GntrJon T. � t y• 44t Lvd7�d� -J-oH y;lle I?dQ, P�.tter`Son, X1.1: / 25G 3 �( 30/98 // ((l'-'0 /v8 yes e:lv5c: fo poncQ Needs 'Pllmp Test- ' Cr I ✓o o 7 Ma l � l Q �. g �>vr 3.i.ac. Y �eq t /O o a l a N ♦Q d � T oP F , / r� .+�I' o f L:, y 5. d /�. �Sr... nrq s 09...'� _ ��_ ' r.. Are . s r :. : . N.:ia.,.. .� .. i. r, s . .a� . s e . r ::�r :- .: } ' ,:.s: •.r ":r t I -, .-`. ..N. ."5.^ .„ . ,.. . Fe R . ,> - r .._ . . r , •r.40 ,r . . . .m ., . � ... „._ 5.. . � r f � a . ,' .., z.. ...�y. . �,... ^'t r T +.F,. ; ..,=, .s . _ ' r . . .,,-'. i_ �.. , v.,, .<... , .�+. Fi.^,. ,0.2 :�... . 1 .� ..^.r . .. ... - .- . . :. xYt. : '°o .3 'x ._e � v9t . M.:. :va5 , -T . . Z.r. . r ai_ s .,.,. ny�. : . am P: c'3a. . ,'a , iy ce 3 . , ..�...1 .. �. .,..�_ . _.5 ':�: . f } b! :,, . � a ._� .w'1.,, , '°r'i� .+ n F+. ,� �1 C 1F c-� ei . . , .cx . •j+_ , Y ^. r•:.._g .q ,i..F , ... i.. .., ..;}. .� ' -5.,x. y. u. .� .. s a _ .. ? .Y, �. .f' ... >� ti?re ...Y..if, S. � a.nl .. w�i 7_�r..c�.,�- Laurel ,l{; // peiufin.9 Hoek W. y ;;dell not ;,v - fL mere Y p earmel , �/, f : lDS�I !/ 1p 5t I U UTNAM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM Located at Subdivision name 67fyW4 % Subd. Lot # LT Date Subdivision Approved Owner /Applicant Name F o ti A C�e ` Mailing Address To or Village �77,WJ0 Tax Map Block Z Lot Renewal ReviAip Date of Previous Approval Amount of Fee Enclosed Building Type &ipSVM Lot Area / No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume �G PCHD NOTIFICATION IS RE UIRED HEN FILL. IS COMPL TED to consist of 14 gallon septic tank and ea�Li./ avv I/ Other Requirements: To be constructed by Water Supply: Public Supply From Address jw7m9w, Address or: 1-�'Private Supply Drilled by %', 43 4 /2> 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 treatment sus em 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. j / Signed: Address License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trey ent system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified he considere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it Approve r discharge of domestic sanitary s wage only. By: Title: L�l�� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 - . � --- .:.., I 1. _ , - . - - - , . - ­ . ­­ , , , ­ ­__.___1.1-j_ 0 1 �" � a a 1'. �,��,�'A­­­ � ,�t;--, 1"', � , 1 ­f,� , - ,;,. - , " -, " -;,�, -.­..�, -, _­__..;: .: �tl,�,� .� , � -, . �­ .,- t, , �, - , , �2' " - I I 1- I - � - , , , " -,-, ­ . . I" 14 � � - . �_N _ .�., ,­,-, . .. , - , �, � . .� - ,., . �'. . - '' �­­­, "`;-­I' ­-, ­�,.-'.­.'­­1­- 0MIJUJIMg mq, ._�4. , . F ,� , 1. � - I . le6a';4" .,'r',.1­11M­,��'-­`,;� . - ,_ - 6 - ­.�:�,­ ".. !-.',.,,:,-- '__-:.1..t::' I - ,-�, "'. ..," .." .,; --�� - 11 - ,f,,,j L�� , � .- , 4 "'.11;', - . 1, * . , �`; , 11 ". " . . . � ,_,` �-.,,�, , �,W­_IW :, �._ "'t". � . .11j �.. .'.­.� . , , , . , ,�, - . - ." , , -,� . 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I I , . : .", - " " -, " , _ , �, .- - - - I I , .,- - - .�, - -, ._7 "': I " . i, ." . - .. ,- ­;. � -;. - � , .,ttla7lt:,�� 110.��!:Lollt�, :.'! �: , '. � .': : ..� � , .: - , _�_: _� __ � � . - �_ - . . . , I . - .. ." ". - ... , � � . -, e , � . '. I ­A�:,� I - . '. -, , 1�:� . . . - '. - -,:;:, .4., ,- 1. .�:, .w - .1 . - t - � v ... .... ... �t,7 , , . , v �,, ,_,; . "I , _-, 1-:­` � -. -i . : _... :�� ". . , , � - I - �!It� .,��t. �_ .�� . __ ` ^ sw ~ ' � ' ! � � l � 4. � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: fA QB Inspected by: C Street Location Town .g r rs�.v Permit 4 ,�— i5-6 — 93 TM _ 13 — 2 _ 8 Subdivision Lot 9.17 ' ©`X,� �.4 . I. Sen•age 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 System a. Septic tank size - 1,000 ........125 .........other ................ b- Septic tank installed level ................ ............................... c. 10' minimum from foundation...:...... . .................. ............. d. Distribt ion Box out ets at same elevation -water tested .............! 2. Protected below frost ....:............. .......::...................... I Minimum 2 ft.Original soil between box & trenches Junction Box - ioperly set .......:..... *....... ............................... . ength required (-,) ;i Length installed 0 c) ~;2. Distance'to watercourse measured t.......... 3. Installed or ing to ... ......::.: ..� ............... • 4. Slope cl eptabl 1M) 1/32" /foot ............. 5. 10 ft. rb line - 2 foundations.......... 6. Dep n <3 i s s o sjarf4ce .................. 7. Roo' rri w r ans 0/0 ................... 8. Size o a, 3 -1 /2" 11rI1 e 9. Depth of gravel in trench 12" minimum ................... 10. Pipe en ed ....................... ............................... g. r osed ystems ize o p c am er ............ ............................... 2. Overflotiv 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/Building a. Houselo cated per approved plans ... ............................... b. Number of bedrooms ....................... ............................... — IV. Well a —4ye11 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 & dir.to exist watercou g. Footing drains discharge away from STS area............. h. Surface water protection adequate ... ............................... YES NO COMMENTS . X K x ? K 100 to �M x 5`r � a�•'l'� -rte. S :� U.Qr eo 5 - nlp�' -�OdHIX LL 71 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 #17 (T) Patterson, TM# 13 -2 -80 Dear Mr. Daly: May 8, 1998 M ., `( T 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) Current codes requires fill be placed in the expansion area. Revise accordingly. 2) Dose systems must be equal distribution, i.e., trenches are to be of equal lengthy. 3) Proposed contours are to be shown. 4) Trench detail is incorrect. Revise minimum separation distance. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer •f. Tiii1 I 0 Ida* of"the lum- /t4- 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 10587 Re: Dear Mr. Daly: BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Proposed SSDS: O'Hara Lot 17 (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." 1) 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. Furthermore, a note is to be added stating all erosion control measures are to be installed prior to the start of anv construction. ✓4) Plan has not been signed and sealed by the design engineer. ; A) Remove'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 further. Very truly yours, �6w N011W Robert Morris, P. E. Public Health Engineer RWI rnh watershed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 44-11 Located at p._ (T)_/ AWXe.SnqJ ger-t r . 1.3 Block Z Lot O Subdivision of 1714 WA .Subdv. Lot # 17 Filed Map # Date. Gentlemen: This letter is to authorize 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 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 Signed Countersigned: ��9 Owner Poperty P.E. , R.A. , # ,�5� �7r A ddress ,)2 J Address Town �f T4lephone Telephone '! NO I N I No AEL WITHIN I o' SIPHON GHA WITH SIPHON 250 GAL. TANK d° ID IN .,HOUSE N EL �/ f20 LINE / z � r O FILL rnrn -f?` GLAY BARMIER R 50.0 rn Numbeir.ad"i pila6seas- SwenOw.aweis, S70, To be esidn'ided W n WOW Pdwk S* Sop Od. lea ti 55 viecii-Jai 000d,operatine cond ONICS of the" ippi ovii: of tt i WW be- Ioeat 0 'iii'slwi" pin",ifte MNlth, /e+youblu for Rev, - 14/88 ------------- LI Amhmif edge Flow G P D_ 8)C3 WMenSepile Twit and Addives. A dilrew "of ukealin will 14 6pullder will tie of 160 issu- *scraw above . the Putnam =_ I k, A. Pal aigpires' two years 4re'rAthe data i construction, a . f thi 6uildirig his been undertaken and is unless Fonstr iiii'vOwn considff'ad�n=e�Mjusry b�v.t mmist4l'oner of IMMIth. Any cnirMp'or Skeratkin of construction .,y .t� au of dome4k sanitary saw Iva ureter su k 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 # F` 6`� WELL LOCATION Street ddress To Village City Tax Grid Number WELL OWNER Name . �J Mailing Addr s. 0.Pfivate O Public OF WELL �SE - primary 2 - secondary SIDENTIAL 0 BUSINESS '0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST/OBSERVATION_ t3INSTITUTIONAL O STAND -BY. O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD 9OUGHT­6� gpm /# PEOPLE SERVED' /EST. OF DAILY USAGE, (,,�)Bal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Lh ADDITIONAL SUPPLY G-REW SUP Y N D ELLING 13 EXISTING WELL REASON FOR DRILLING. DETAILED REASON FOR DRILLING _DEEPEN WELL TYPE MWRILLED DRIVEN DDUG O GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES ` NO IF WELL IS LOCATED -IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Ft) Address: IS PUBLIC WATER*SUPPLY AVAILABLE TO SITEt YES NO NAME OF PUBLIC WATER'SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /1 LOCATION SKETCH & S URCES OF CONTAMINATION PROVIDED to SEPARATE SHEET (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: 111. Pump the well until the water is clear. 2. Disinfect th,e.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 otherwis am na surface or groundwater. Date of Issue: f' �f;% ' 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 I PUR M COUNTY DEPAFrIIMENr OF HEALTH IT DIVISION OF ENVIRCNMENTAL HEALTH SERVICES DESIGN DATA DISPOSAL a • �u Located at (Street )�a,)T;:;- 311 I C-Rif,4- c, See* tO Block -Z Lot (indicate n est cross street) Municipality Ctr,:c- t�?�l ^, D Watershed G--� 4 5 2 2 j �S I �' �Z 1 3 a Zq Date of Pre - Soaking � t (Pj t_ Date of Percolation Test 4 HOLE NLVBER CIDCR TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop, Drop In Min /In Drop Inches ` Inches Imps 4 5 2 2 j �S I �' �Z 1 3 a Zq 4 5 NOTES: 1. Tests to be repeated at same depth until apprcaimately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RMUIRED TO BE SUBMITTED WITH_ APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 13 G HOLE NO.,, HOLE NO. G.L.• To 2,- (L- 21 3' �l 4' 5' � 6' �1 7' '•Y 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNMTER IS ENCOUNTERED I�� �I►14Tt3�7� �l� INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: '�j� 'Do.6.44 DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided 10,Coo d\ No. of Bedrooms Septic Tank Capacity I ZG} gals. Type Absorption Area Provided By E300 L.F. x 24" width trench Other Q6&j 6 C7'g4,7t&yyl' OV,AC`, 1CrN Name CONSULTING ENGINLER Signature P. 0. BOX 243 Address SHENOROCK, N. Y. iosv SEAL C. �O 040A'' THIS SPACE FOR USE BY HEALTH DEPARM,1FM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date Addwo thereto . : a*rbd in . accordance.with th . a standards. rules Ong regual ions rulner" "nty - Da�!jrl;,'o Health. and that on completion thereof a IT pl. be. submitted t and w!!t!ah. . guarantee 'will be iumi the his 114cceswS. "Irs or OPsillis by the builder. that, said bulklat will 06 Jd sawage:4114"t System ar4e of the spp�ovil 64'C404iflikte of i�'oniiruct;04�'-4torn"plio'n-co- :'o'f "the privinalygern.or any r her 2) that the drilled wail described win be W.StO6 ifshowift the approvid plan' and that mid well will be Instal ce, to r Aules and reg—uMWn—sof the Putnam APPROVED 000 CONSTRUCTIOW ThIlApproval.eXPirdS two year$ from the data'-Inuod unless constr.uctle/n of the building has been undertaken and is re4ocap!e for �ca�s;s or rnai 14� Or' mod Ified when . ccinsidered'nacessary by the Commissioner of Health. Any change or alieration of construction r"uirGS.O-h'iaw,poOrrnjL. 01par"edJor d ao 'f *51'ic iinitary sewage, and/ at. water Wpply only. Rev. ' 10/88 w�* ` \ 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 Address U o Village City Tax Grid Number u �`J °Z.�'T�C� WELL OWNER Nam � Mailing Address 43 ivate 0 Public USE OF WELL - primary 2- secondary EV6SIDENTIAL 13 PUBLIC SUPPLY QAIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY 0ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT Z5— gpm /# O REPLACE EXISTING SUPPLY EWEW •SUPPLY NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGEgal 0 TEST /OBSERVATION 12, ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED' REASON FOR DRILLING Or WELL TYPE al)RILLED DRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C__NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Z-1 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED Clog SEPARATE SHEET Re19��3' (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 thirt -y (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 cogtaminate surface or groundwater. Date of Issue: '� �/ % 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date q I g Re: Property of r, Located a-t -7 M . ti.l c , et ie -n �. '3 Block T f Subdivision of o•'p �-h��. Subdv. Lot # Filed Map ##i "� �i ?jCpO:� 'Dak T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENQRQ'rK, N X 1n 8,7 a duly licensed professional engineer or regist x_e (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. rf Very truly yours, ned Countersigned / Owner of Property 1? C, P.E., R. A. # Address T. MICHAEL DALY, P.E. " 'P01_ MO WINEER Address Town P. 0. BOX 243 SHENOROCK, N. Y. 10587 Telephone 9f�- z a� Telephone a v � P UT NAM C OU N TY D E PARTMENT O F H EALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: N, 17- (a 2. Name of Project: ��ll N •3. Locatlon4jvV/C: 4. Project Engineer: ' 5. Address` -?DO)( Z4� License Number: 48 4'6 Phone:-.-q-A- 6. Tyve of Project: Private /Residential Food'Service Commercial , Apartments Institutional Mobile Home.Park , Office Building Realty Subdivision Other (specify) 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? ............. 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? ....... ............................... "5 ►-v TJ9:11- 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.`�J.'>, LF. Surface Water. —Ground Waters 15. If surface water discharge, what is the stream class designation'........ 16. Waters index number (surface) ........................................... 17. Is located a project near public water supply system? .................. 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 A. Date observed: 23. Name of Health Inspector: A. Project design flow (gallons per day) .......... ' o .................... 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 3 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? 30. Does project require a DEC Stream Disturbance "Permit ? .................. 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 tJ 32. Is project located within 1,000 feet of ,existence of abandoned landfill, hazardous waste site, .salt stockpile, landfill, sludge disposal site ar O any other potential known source of contamination? ......... l....... YES or NO 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 t Applicant Engineer pp o be returned to : ............... 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 oq. this form is true to the best of my knowledge and belief. False statements M" de herein are' punishable as a Class A Misdemeanor pursuant o Section 21ti.d, of the Penal Law. SIGNATURES & OFFICIAL TITLES:i MAILING AD DRESS: X�3 ►�i�i i�:�i i�i�i °i�i�i�i °�� T. MICHAEL N 1 ' 1 BOX 1'1 D-ss s • s - Ignature_& Title .0 24 i L. BDRM #I r GL. HALL G _ 5DRM #2 BURM #5 S4fGOND FLOOR 1/8" = I'-O" . IA- = ter. Apo MA5TER $DRM