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HomeMy WebLinkAbout0369DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -82 BOX 5 00178 Le b-pl ...r �� ,T 00178 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C TIFICATE OF CONSTRUCTION C MPLIANCE FOR SEWAGE TREATMENT SYSTEM PD ONSTRUCTION PERMIT # 3 (1P. Located at Owner /Applicant Name � S /C Formerly / � r#4e.4 Mailing Address Date Construction Permit Issued by PCHD Town or Village ©N Tax Map 3 Block Zi LoteZ Subdivision Name 1�) hww- ir Subd. Lot # 3-7 Zip _ Separate Sewerage System built by X //a Address Pb P:>6 -,r Consisting of _ Gallon Septic Tank and j Other Requirements: Water Supply: Public Supply From Address or: P:1,5/ pply Drilled by �� C A Address t � Building Type 1��'L. Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? V-2 certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (co ies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and th tandar, s, rules and regulations of the Putnam ounty p ent of Health. Date: �i Certified by P.E. ` R.A. � "DS ional Address License #— Any person,occupying premises served by the above sytem(s) thall 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 ,' difica or change is necessary. By: f ✓ Title: (�i'� Date f White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Located at PUTNAM COUNTY DEPARTMENT OF HEALTH VISION ' OF ENVIRONMENTAL HEALTH SERVICES CTION PERMIT FOR SEWAGE TREATMENT SYSTEM �9 Subdivision name i A AR A, Subd. Lot #-1-7 Date Subdivision Approved Owner /Applicant Name c- 1 Mailing Address Town or Village"]�A't `E ZS O A/ Tax Map_ Block a Lot Renewal_ Revision Date of Previous Approval J d 9 Amount of Fee Enclosed Building Type \bENTt q QLot Area ,- tAaN . of Bedrooms Lf Design Flow GPD Zip Fill Section Only Depth Volume PCHD NOTIFICATION. IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of %'.430 gallon septic tank and yS '% a r L 1 /V% F T Other Requirements: Par VV!?Q M-? 3 A LV ALASM 'RO-k� 5: u-4. (Atke) To be constructed by C 1 ,c-L Js i c, V4 o Me-5 Address Water Supply: Public Supply From Address or: r/- Private Supply Drilled by ©� 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 system 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: Address R.A. ,icense # �. 101. &7j =z1v APPROVED FOR CONSTRUCTIOW 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 modified w nsidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pen-dl pprove r discharge of domestic sanitary sewage only. By: Title: �!� z-- Date: ef White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address,,' Located at (Street) �` �r'� Tax Map Block Lot 9z (indicate nearest ross street) Municipality Draina e Basin OIL PERCOLATION. TEST DATA Date of Pre - soaking Date of Percolation. Test Hole No.. Run No. Time Start - Stop Ela se Time (pMin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate, Min/Inch 2 1v,, a Zy 3 : :L5' -10'! 4 Z Z/ 4' 5 1 f 2 /�r' ��� J l ,i 2_ 3 0 4 5 P�E0 PlEyyyp" 2 4 �o ESsso NOTES: 1. Tests to be repeated at same depth until appr mately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for I- h, s 2 min for 31 -60 min/inch) All data to be submitted for review. 0:9% oz. s 2. Depth measurements to be made from to . Je. VA AN3 � � q 1.410al n 8 .. Form DD -97 03A13038 PurKAM count DEPARTMENT' OF maTe L . � Division •[ go" Services. Carded. N.Y. 10617 Enab•ar to PwvW P•aaalt g as CF.RTUITCATE OF COMPUANCR NSRQCIiON MMIT FOR SEWAGE DMOS" SYSTEM jJ� r_ f��- % •,� Iftew at Vl ?lzx� /)V) /40- -or gtislaidd.a 1 tJi'�al f� s.e.t. Lee M 3 1" map -- L- ..1- -g }ac Y9 o Iof - .fit Renewal— Revislse Q Date of Provisos Approval i <.:` ,/, ' y -r "' MaWR Addnala L, IC.% 9C L Town I4 i�J, `7i� yp f �' °? � ✓ . JL-LU Vubdivision ADArOV -%k 1 r:p VA Fee Enclosed ❑ Amn,mt B111111110a 4P• J 1)i rV�r ,ail, . Lot Are. Fill Boobs Only Depth . Er Valame °yt 1 N•aabsie of Betbo•aas Dea141t Flew G P D �' ^' j PC® Not<lkatba is Regains! Wbea FIR 4O•uapiew Sep•pate S"My S] a eaadat et S Genoa Septle Took oW '7Z2'.--L- f' T • ' .�: ' FA, �: a To be orntructed by e' i ,P, Address Water SW*: P&* Sappy Ftfao Address on 4'-f-Pttivate Supply Drilled by —I ti, P r.ddran Odw it"atraes.t. 1 i 1r era y Y, ;" W ! ►-ir •f t' 1l I6' fl a. Af:'N) , t , `:i t' i:? t� Y'yiL�i�. k, tIN �1( 4f)%; `Y G 6 ,+ �••T / I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate Saw age disposals stem above d•fcrib•d will be constructed at shown on the approved amendment there to and in accordance with the standards, rules a regu eons o • nain County Department of Health, and that on completion thereof a "Certificate of Construction CompOlance" satisfactory to the Commission of Health will be submitted to the Oipertment, and a written guarantee woo be furnished the owner, his successors, heirs of assigns by the builder, that sold bulkier will Mc* in good Operating condition any part of said saws" disposal system during the period of two (2) yon Immediately following the date of the Issue 1n1C• Of the approval of the Certificate of Construction Compliance of the original system er any repairs thereto. 2) that the drilled well described above •NI be locatod as shown the approved plan and that told well will be Installed in accordance ,}oath the' stan4ards, rules and regu Eons of the Putnam :Ounty O�f !}Afflonnt of sr Ith. ) �• `�" ,/i� J- .r!'� Tat• �/ 1 Si•ned !3•'� .''�` - P.E._ R.A. _ Address / "�' /V/ / License No PPROVED FOR CONSTRUCTION: This approval expires two years from tAe date issued unless construction of the building has been undertaken and Is rouble for uusa or may tle amended or modified wMn considered noc"Sary by the qa mission Of Health, Any change or attration of construction Quires a new mit. Approved for a: g .� / disposal of domestic sanitar rs}eiage, and /or ,pr ite ,water supply only, t• __,� �> M J eY Title , .�`.M�L!M7+!.ai,;cj4".. a '•`'ii'`.a..�......il?''�•,,. -� i rte.." .�,,.,i.!. its___ L�•',., `,- '4ww�:LCt 71�+J.uw..L!wr n:`�, •+k4,r+.. :,+, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by L &ation - Street P�_&Jy_,14m \1 Building Type F6 7 4� TownNillage (2w 4 e_ . Subdivision Name Subdivision Lot # X37 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 wheth the failure of the system to operate was caused by the willful or negligent act of the occ pant of ih . building utilizing the system. Dated: Month 7 Day Yi' Year I1 A U General Contractor. (Owner) - Signature Corporation Name (if corporation) J Address: State X � Wlx Zip Signature: Title: C wi Corporation Name (if corporation) Address: State .WZip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` FINAL SITE INSPECTION Date: 7/ Inspected y: 4 Street Location x1126,6 V/jE y 'Dr, Owner Q `Hd Z ,4 Town 2AX:-Ce g!s ew Permit # p -- 5'9 q' 3 TM # jam' — g Subdivision Lot # _I 7 "12s�aCa ey;crw 04 � 1. SewaLye 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, 250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. Alt 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 length required S % _ Length installed 2. Distance to watercourse measured -�-oFt.......... 3. Ins d cco di Q to -'la .. ....... ............................... 4. S e 'f ch acc f e /16 -1/32" /foot ............. 5. 1 . fr ropert 1& - 20 ft.- foundations.......... 6. Dept of trench <30 inches su ac .....L .... 7. Ro 11 e$ la io ° 8. Siz gr 1 is eter le .... ..... 9. Depth of ravel in tr rich 12" minimum ................... 1 i nds capped ........................ ............................... g ult Dosed Systems e o 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 ................. f..../ .......... IV. Well a 1( u�-f r Irs a. Nell located as per approved plans . ............................... b. Distance from STS area measured -/- A00 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 ............... ...........y 14 d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 'I-1 0 r � ie imam Wam imm IWAM imm INIMM IBM Imm I�- I�- IBM INE I"- SAM 'I-1 RE Ao NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 LA$$' 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT. TO: MILL DRILLING, INC. DATE SAMPLE COLLECTED: 6/21/99 & 7/7/99 75 PUTNAM AVENUE TIME COLLECTED: 11:30 A.M. 3:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: BOB MILL DATE RECEIVED @ LAB: 6/21/99 & 7/7/99 TESTED BY: LAB# 11471 REPORT DATE: 7 /12/99 SAMPLE SITE: DORSET HOLLOW BUILDERS" RIDGEVIEW EST'., LOT #37, PATTERSON, N.Y. SAMPLING POINT: TANK — HOSE BIB SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: 7/7/99 - Color 0 Odor ND pH 7.52 no designated limit 7/7/99 - Turbidity 1.5 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N 11301- Nitrate N <0.50 mg/L as N 10 mg/L as N Alkalinity 68.0 mg/L no designated limits Hardness 90.0 mg/L no designated limits 7/7/99 - Iron 0.125 mg/L 0.30 mg/L Manganese 0.098 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6.4 mg/L, 20 mg/L ** Lead 0.003 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:6 /21/99 & 7/7/99 SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 Date- _Subdivisi ip4ed" Fee-. =Enclosed Ut� fl dMft A I* A imsm AC Ipm IS e W1,4-1 � Go gi, " ci'm d jk Tfieil Z I ZS4 yx ::�, r forth ei"44 wholly and. cpmowt!!Y� e!F 1, pars Q* �!_4qS -Wwa": dissio"i system ! I, - approval amenAmant then to and m above tlescri0�d will ba !!strlictad AS show. � the Putnam, �,,Ez -iiii County WWrtmant ;of _,�and. t '. I ­ J a on porn ion Plat '_C,i_h` f, '4eGAIW idi� lsfa�tory to tfii.!Commisslqi !T�pf .and -s written; 6►s by_,lha liutldei that joW;uullilili­Will Ion :any 'part o% �.the ism.. tris� drilled well &M, %86049 .W11111:1se4ocated SCUtarm n the approved pMn .a that Yid wall will M InftalNO 'i t, t r ru=Wn_ *T.'�'I' "I"i Put" Pat* Q C AtlAne License No x' APPROVED FOR ',CQNST Y! !s: from I n.,61 the building fts been'4nderta " or4!n�pad,!k"n 't" � t ealth. Any change -or'aliwition'of -construction requires a permit, !: only. zsu. ly. Rev. -00 10/88 Title WE`LL COMPLETION TION RE Of f: ice •Uae DEPARTMENT OF HEALTH Div'ieion 'Of Environmental HealCh Services PUTNAM COUNTY DEPARTMENT OF HEALTH �o-t,C WELL LOCATION 0RE55 WNI ! TAX OR W NUMBER: WELL .OWNER' ' ADDRESS ' Cr.:as;, P81VATE'. P08LIC r USE-OF' :WELL' t�E 3OENTIAL 0 PUBLIC SUPPLY : p AIR %COND /HEAT PUMP, ❑ ABANDONED 1` primary ` I' t1S!ldESS 4 : ❑FARM „. 0 TEST /OBSERVATION 00TH (specify) seconda2 O INSTITUTIONAL., O. STAND -8Y ❑ MOUNT10F US I sOUGIfT opm "' PEOPI, SERVED ,1 EST,.OF DAILY USAGE ���.rgal r . .;�... -/NO: _. . REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY.,.' TEST/OBSERVATION s° DRILLING .' � ; <t31t,(ISTING SUPPLY "U DEEPEN EXISTING WELL DEPTH BATA., WL` OipfH /a ft :STATIC WATER LEVEL 9 ' it. DATE MEASUREq 6 ho DRILLING', lfiQ'CtY COMPRESSED AIR PERCUSSION, Q O 'DUG EQUIPMENT { ,Vj L Pt33N'C .... -,O CABLE�FERCUS,SION t7'OTHEA (specify) , WELL TYPE G� SGf NED O: OPEN END: CASING OPEN` HOLE IN BEDROCK O . QTHER 'l�QTaL LEI f3TH ft: -: MATERIALS , STEEL '; PLASTIC '. Q OTHER • ' • . CASING LN" ',i EL!7W'GRADE . ft, .JOINTS ,. 0 WELDED THREADED I� OTHER; DETAILS ;SEAL: 0 CEMENT�GROIST' 0 8ENTONITE'_ oTNER a 4 iC�lT DER FOOT ;: ib !ft = .; 'DRIVESNO.E. YES ❑ N0. LINER: p YES NO . .; SCREEN f�tAMETEA Iia) SLOT Si2E' . �FTiGTH (ft� TO SCREEN (it) u�ri:LuFEitiY • F. DETAILS o Yfs 0 NO ...,.. .. a .. , ..'...,HOURS GRAVEL PACK DYtrS 'RAVEL ".' DIAMETER•': .' TOP. BOTTOM Q N0 $ICE. DF'PACK fn: DEPTH ft. ; OEM NIt. WELL YIELD TEST It detailed pumping ff .snore detailed formation. 'descriptions or sieve WELL LDG :. analyses r M 00 :..D PUMPED #acts Crete done Is in �Q� !!l COMPRESSED i�i0` `1166 'attaoi eo? are avatlabfe, piease'attach. 5 DEPTH FROM :SURFACE Water Weir 01a' 0 BAILED O OTHER ; O' AS 0 NO tt. . ttt. Bar- in9. �cter ... , • FORMATION OESCRIFTION cou ' a, " WELL DEPTH 'DURATION t)RAWfldVN ' ` YIELtY ' ' Cnd Surtoce ft r T F S tt i' :VltATO CLEAR' ` 7Ehti' QUALITY "O CLOUDY HRPtfIES51 t 0 COLORED , ANl4�'Y2�?� +- O YfiS ONO ; ANALYSIS ATTACHED O -YES ( 'ONO S T'OR'A GE TANK: ;TYPE PUMP INFORMATION CAPACITY GAL. TYPE CAPAt iTY " WELL'ORILLER NAME ', •, M 'HYATT &',SON5r INC. DATE MAKER pEPTH ... Aa �E�SER7 > W t DntA • ng stGr>rtiURE • el MODEL HP Rte:. 3.11 :. R R. 2 . ;'Box 171A ' ,,.NEW'. YORK 12563 `' '. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL P y PCHD PERMIT # ,/ 9_:�, WELL LOCATION . Street dress o , Village City Tax Grid Num r WELL OWNER N �e Mailing Addre p , OP`rivate O Public' USE OF WELL 1 - primary. - secondary ra i� RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION O INDUSTRIAL U INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT <T _ gpm /# 13 REPLACE EXISTING SUPPLY RtE S NEW DWELLING PEOPLE SERVED-g /EST. OF DAILY USAGE 6 Sal O TEST /OBSERVATION Q ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED .REASON FOR DRILLING WELL TYPE [E DRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 1, 3, -D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L.--'NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED QbN SEPARATE SHEET - t� (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 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 m �er as not to degrade or otherwise contaminate surface or groundwater. c Date of Issu�� Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller MUM punm f DIWAUI� OF l�AL1S 14 , L Sivellimilifilt �� I �i zI. ., 'J� - . .. 11 , -- ". "01h1!4411 AP,!" D" place in-,qood. qparatw wwo of the �apqkowal of wirm tN County D"mirta . IW'O! bete iii r(4 APPROVED FOR CONST reyouble,for'CAUSS or "sal "QU,reS - p, erm - , t '� L a saw ";,y Rev. 10188 0 a the 900irift saw 114 4L Vl i stern ru!es, " 'allulations m nam ry to the Cornmisiloner it keetthWill I t y the b4lklii►, that raid buikw will Metal If 'follo . wine I the dati40 the ISM- the Arillad.wall`dasoTibeO above It and rig—UMM-5611 the PiAtnam 0a MIA I the buillding bas been * undertaken and is Any 'change or alteration of construction Title- 71 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road-, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL a PCHD PERMIT WELL LOCATION Street ddress i i�� o Village City _ c'r'y Tax Grid Number ;7J" •Z WELL OWNER Name Mailing Address -, '"� �' f ZT1vate 0Public diE OF WELL primary 2- secondary EWSIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT UMP O ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT z-5 gpm /# E3 REPLACE EXISTING SUPPLY M-n"W 'SUPP Y NN DWELLING ) PEOPLE SERVED (/EST. ❑ TEST /OBSERVATION 13 DEEPEN EXISTING WELL OF DAILY USAGE gal Q ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE M KILLED DRIVEN EIDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES C- NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Q 144Nio 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: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 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: 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- anrLa-t- e__9_urface or groundwater. Date of Issue:— r 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 z Re; Property of � /`�/aC"5Z4OS0 Located at 12.p �E w ,e«e (T) Z Z Subdivision of 0 /%'W Subdv. Lot # � 3 7 Filed Map # Date Gentlemen: This letter is to authorize �E.t9l� a duly licensed professional engineer or t (Indicate to apply fora 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 D eDartment of Health, and to sign all necessary papers on my behalf in c ,anection with this matter and to supervise the construction of said s }stem or systems in conformity with the provisions of Article 145 or Education Law, the Public Health Law, and the Putnam County Sani- ti'y Code. Very truly yours, Signed Cantersigned: i caner, Property P.E. R. A., ZY 6 A/Z�• -,�C� Addre s Town P' -a /3&x Afdress vV -77 i5`77_3 `11ephone Telephone D• BRUCE R. FOLEY Acting Public Health Director `(4- DEPARTMENT OF HEALTH 1 Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278-7921 Sean Daly November 5, 1997 Box 243 Shenorock, New York 10587 Re: Proposed SSDS: O'Hara Lot 37 (T) Patterson Dear 1%1r. Dah•: 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." ngineer's,authorization has not bee igned by the property owner. �) rench cover is to be noted as geotetile on trenc pan. rosion 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. ;4plevise an has not been signed and sealed by the design engineer. fill notes and specifications to current standards on fill plan. "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. ri (( c°G j' f cat )per coo- -n R1tiUmh watershed . Very truly yours, 73, �,`> �," ` New Robert Morriss, P. E. Public Health Engineer - ./U`ee&�-;, BeGt1t'i tq 4 LD1 -5t �l� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (9.14) 278 - 7921 Sean Daly Box 243 Shenorock NtY 10587 Re: Proposed SSDS: Macaluso Ridge View Drive, Lot #37 (T) Patterson, TM# 13 -2 -82 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) A fill plan is required for fill sections greater than 2 feet. The minimum of 2.5 feet of fill is required for the entire SSTS. 2) Current codes requires that fill is placed is the expansion area. 3) Current codes requires the pump dose is sized to 75% of pipe volume. 4) Trench detail is incorrect. Please revise. Upon receipt'pf a submission, revised to reflect the above, this application will be considered further. Very-truly yours, 11 y, Row Robert Morris, P. E. Public Health Engineer RM:tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL i (�- please print or type PCHD Permit # , Well Location: Street Address: o mVVillage Tax Grid # Map _ Block � Lot(s) li Well Owner: Name: Address: 117_ '2 7 5- j= z.: /NI% 1Z 3 Use of Well: j esidential 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 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason tai) for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? .............................................:... ............................... Yes No Is well located in a realty subdivision? ....................: ................................................ Yes_Z Name of subdivision �� jyr5 ��a `; t� 9 _ L� -- Lot No. 7 Water Well Contractor: i�, J _. Address: Is Public Water Supply available to site? ........................... ............................... .. Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed ll to ation & sources of contamination to be provided on separa a sheet/plan. Ill c ': Date: Applicant Signature: PERMIT TO CONSTRUCT A WATER , LL This permit to construct one water well asset forth above, is granted undi provisions of Article 10 of the Putnam County Sanitary Code and 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 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, a driller certified by Putnam County. 4111� Date of Issue Permit Is . Offici . 6 Date of Expiration - Title: Permit is Non- Transfe rabl . White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 FUTNAM COUN Y DNlARTAENT OF HEALTH DbYw et io�aalal Hattti ServOoba: Cartaol. N Y IgM is Paivlde Fe �r w OF COPAPU N 110 -►;GE LS F.aaK,r at Tas ltevLkn Dade et Freviml Approwl Mrllls Add,wa C7` 02, Town �P Date ubdivis16ri'A Fee Enclosed 0 owmbe Ty" Let A. /� %%5 /fGr z,-57 vdtmab y�s� Nh�bee d Heioenp DidW Flow. G P D PCHD N Revatted Wtteo Fm le oahapkted _ . S"WaM •Sew eap Symeme /ti flamt 1 * � Ga54 Sep de Teak ' b7 ` Water Stappb: /F Sib s Adilmr Near' tJM7 �i i W i� )-- e .4-/� kL�eM A Z 11-5, � � fd +� .�IU �4 P��, �JiZS C- ,, I;reprasent' that 1'am wholly "' CompNtaly risponsiplri for_i Oetgn'and location of 4ha proposal system(s); 1) that the feparate saiwage di fah s stem above' described will b�'constructed as shown onthe approved amendment ther'e'to and. in accordance with the standards, rules a reyu ions of n m CouMy.,Oeph%KnNnt;,'of MMIfA, arhd thuf on compNtkrn thereof a- Certif�cati of COnsir t- aien,COmpliinp fitisf ttoiy to the Comm selerw of Meaffhwill d• ohbmtttad to aM Depeitinwrht; an0 i written "gWrantea will are' /urnisf ea tea owner, his tYccesefs, hel►s or assiiinhs by.tha builder, th t said buledar will Place, in flood .operii ;;iilon; any ,part of said fwwaOe d,spoul syitan+ during the period of turw(p yMrs.tUnnnadietely fonowing.thedata of the Imu- anKe of tM'appia,ft of Ire Ceru kate o/ Construction Complwnci of tea orginal system or,any'r, Ms t eto; Z) that the drilled well described above well be located as ahosvtl n the approvid plae'and that said well will tsar Inter in accor'danp ' th t a 616 rules and rpu a�iiionni -of'• the rant Count O - Rom 01` Ith. - - 0� Doti Sgned' P.E._" tA t Addre License No 7� APPROVED F.OR CONSTRUCTION This appro4al eapiro$ two year's -fro t data dffu unless construction .of the building eras been' undertaken and is revocable fo►:uu or may W ahnendal or modified when eonsidaed n s by :the' Issioner of Health, , Any charge or alteration of construction mQuires a, now mit. Apo ad for disposiL of,domNtic fanitar' ,- and /,q:' I to vrater Wpply'OMy. � Rev. 10/88 Data er Tits. 0 a 1)I�:l�ll l �a 12" 1 R" 24" 3011 36" 42" /4801 5411 60" 6611 7211 78" O'HARA SUBDIVISION '1't Sf PIT DATA 1U)JUJAILD '10 136 SU131.11'1'1' D W1111 A1'1'L1(Wrl ut l - SECTION 2 DM(1U_L'fJL0N Or GOUS L•14CCX101'0tW IN '1'L• f HOLES IULC rJ. 3 7 A IIDLE 1JU. 37B 110111; I U. 37C F, OLIVE BROWN LOAMY SAND Rock A 4.5 ft . ' TOPSOIL OLIVE Brown SANDY LOAM TOPSOIL • BROWN SANDY LOAM ROCK 0 6 ft. Rock ® 5 ft 04" 111)ICA1E LGUL• G • AT Milat GROUt`i0W1= IS ENOOUNTEPM None e 111DICA1E LEVCL TO W11ICU WATER LEVEG RISES AFMI BEING AUNT MED N/A I)E[P HOLE OBSEIMTIONS t ME BY s J.F. E BE RL E DATES 9/6/88 ... _.__ DESIGN Soil Date Used 18 Min/1" Drops 8.0. Usable Area Provided Ito. of Dedroat 4 Septic Tank Capacity 288 gals. ' Absorption Area Provided By _ 571 L.F. x 24" width trends Wier 2.5 ft. fill; alt. design or dosing requ -r%e w t><vlc3 BALDWIN & CORNELIUS, P.C. Signat•� � � � =a. = Q IvMress R D-5., Route 22 BEIM O0 1980 • ' � ���,• 38S, • ' Brews ter . New York IQ509 E 0 �, � A FESS►c �'� 01111S SPACC FOR USC DY 11rJUA11 DCPA1t1I.1CHr ONLY: •''• +•+...•� "' soil hate Approved sq. f t/gal. a tecked by Date LOT 37 SECTION 2. ran yvi OOu ny nCr71R11 gir or iLFJ um DIVISIMN or nN.ctu 1"U. 7= I11✓l1UM SLlMCM DC.SX11 LAXA SHEEr- SUBSUMCC SDIAGE UISFOML SYS'1'M FMC IU. Omier PETER 0_1rARA Auldeess P.O. BOX 282, PATTERSON, NY Located at (Street) ROUTE 311/CROSS R08D Sec. _ 10 Block 2 Lot 11 UndL ate nearest cross street) : muticipality PATTERSON Watershed _CROTON SOIL PERMEATION 1£ST DATA RDQUMM 10 BE SUIki17T ) wnil AFFLIClYnms Date of Pre - Soaking 9/15/88 Date of Percolation Test 9/15/88 HOLZ Run Elapse Depth to Water Fran Water Level tlo. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /Jn Drop Inches Inches Inches 1) 1 11:51 - 12:21 30 24 25.75 1.75 17.14 2 12:21 - 12:51- 30 24 25.75 1.75 17.14 3 12:52 -1:22 30 24 25.75 1.75 17.14 4 L 5 ' 2) 1 11:51 -12:09 18 24 27 3 6 2 12:10- 12:34 24 24 27 3 8 .3 12:34 -1:04 30 24 26.5 2.5 12 4 1:04 -1:34 30 24 26.5 2.5 12 5 'tt - C_ f New } r t�C ITS: 1. Tests to be repeat ea' at came depth until apL)rcxlmatc1y equal coil rates are obtainod ,at oach Lxervolation test Dole. All data to' L--- subnitttrl for review. 2. Dcpth measuronents to lie made fron trop of lx)lc. r.ev. 9/05 S i i 4 O� ? ' 0 r 9 ;�;\`���- LD ?.P JA,� l� ��L ♦ ♦ %: 2 4 I . t�•'� . SFAS t�C ITS: 1. Tests to be repeat ea' at came depth until apL)rcxlmatc1y equal coil rates are obtainod ,at oach Lxervolation test Dole. All data to' L--- subnitttrl for review. 2. Dcpth measuronents to lie made fron trop of lx)lc. r.ev. 9/05 S i i 4 PUTNAM COUNTY DEPARTMENT OF HEALTH; DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of D �Q Located'.at M �2 (T) �� -jti.j C =�-�= - -- Block R I Lot Subdivision of \A A Subdv. Lot # Filed Map , �i ?7(t�0 Date ✓� T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize. SHENORMIC, N,.y 10587 a duly licensed professional engineer � or r T;S+orP� (Indicate to apply for ,a Construction Permit for a separate sewage system, to serve the above noted property in accorda,nce,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 provisiorig;;af Article 145 or 147, Education Law, the Public Health Law, and.the,Putnam County Sani- tary Code. Very truly yours, Countersign �2%�C Owner of Property P.E., R.A., #, `Z Address T. MICHAEL DALY, P.E. Address Town p.0. BOX 243 SHENOROCK, N. Y. 10587 q1C,�- z a4- Telephone Telephone • v � P U T NAM C O U N T Y D E PART W E N T O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 01 696 2. Name of Project: Location(j�KV /C: !+ 4. Project Engineer: 5. Address:,_V�DO K 2 �� License Number: Phone: —DSO 6. Igoe 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 Revi'eW (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted- 8. Is a Draft Environmental Impact Statement (DEIS) required? CIA 9. Has DEIS been comp leted and found acceptable by Lead Agency? ........... 10. 11. 12. 13. 14. 15. 16. 17. 18. Name of Lead Agency - or other of:fic in an area under the control of local planning, zoning; Is this project in ordinances? ......... ................ ................ �►_p_ u_"i? PT" . nl. o If so, have plans been submitted to such authorities ?* .................. ,, Has preliminary approval been granted by such authorities? Date Granted: ^ Type of Sewage Disposal System Discharge.,�Y`'. > Surface Water Ground Waters If surface water discharge, what is the.stream class designation ?........ _ Watersindex number ( surface) ........... ............................... Is project located near a public water supply system? .................. If yes, name of water supply Distance to water supply 1.19. 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: l !4. Project design flow (gallons per day)........... 0 .................... ,. 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. b 26. Has SPDES A pl,,i p cation been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated! Town or'State ,l U wetland?............ ........................ ............................... N 28 Wetland ID Number. ....... ............. 29. Is Wetland Permit required? ... ......................................... Has application been made to Town or Local DEC Office? ... ............ t.. 30. Does project require a DEC Stream Disturbance,Permit? ...•.. ........... U r, 31. Is or was project site used for agricultural activity tnvol.vin g application of pesticides to orchards or other crops, solid or hazard;ous,waste disposal, .` landfilling, sludge application or industrial activ,tty? ,;;.... YES or NO N 32. Is project ,located within 1,000 feet.of,.existence of abandoned. landfill„ hazardous waste site, salt stockpile landfill, sludge-disposal site..'or any other potential known source of contamination? ............... YE$,, or NO DESCRIBE: 33. Is there a local master plan.or file with the Town or Village? ........... 15 1�,b 34. Are community water, sewer facilities planned to be developed within years? 35. Are any sewage disposal areas in excess of 15% s.l.d e? .........:.............. 36. Tax Map ID Number . ; ... .....r.. ".l ...Z �. ......................... 37. Approved Plans 'are to be returned to: ................. Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization.. Failure to comply with this provision may be grounds for the rejection of any submission. 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 2,10.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: C. MAILING ADDRESS: T. MICHAEL DALY, P.E. BOX 243 SHENOROCK, N.Y. 4 BEDROOM COLONIAL SINGLE FAMILY RESIDENCE G BATH DRE- s�,lt�lb L. I BATH o ROOM BDRM #I GL. GL. GL. HALL . G L. MASTER BDiZM #Z BDRM #3 BDRM 25 a SECOND FLOOR L D MUD R R.00M Y EATING KITCHEN BTUDY G G AREA ALT14 LIVING 2q' HOVIF t -T.cT� ,, L, ; _ 14 ROOM BE'D"C L 1, ^A i T - DINING oom FrqFOYER 24 FIRST FLOOR I /8" - 1' -0" OF a 7 x' t, ,I- , �, t x 23 2s ' y tf3. Yrr S c r., } ..'}1 Y S _t t r : "•` Off' ! S i ,. 'r -.r?. ,! ,yyam t 41. �, zYf'� S F A t. / T 1p y 1 T 1 tr` _ J �t. - ,, + x .. Y " . f, l f I t ,� , } t - t _l r ° fi 1 e r j) 'r �� r 4/f F :. / : t i rs r ill I _ arti._ +.� t 1... � � "}i t t fi ! 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NIAS fONRY iN/ PUMP, 1 s,� r L 11 i. t f Y . -S i 1 S i l 1 q,. 11 `a ` TANK: S Y , p , r L. yI ,rY's Y I.... z"'t '� t t.° ? Y ra ''"'- Jt r°4 to a, h �r. Ito ! f' ✓- S r ( )•-' G < !, . . tr` . R ° 8 5 t rr I�� Bin, S, :t 5t c £ it x�i `, r• i MF.,pyM s ! a' bza- . t w �"t.! t fix'- x r � A ��'.' .7 ° z. x 4 �, t y r y / : "p y". S. 4R A A 1 'J ; I 14. G' , ,fit fa. 0 �J .• t 1 t. 11 - L. I .c `�* 5Y5TEM: REQUfREMENTS 1�, ,1 t% + r �, d7 4 1, .r 1'rj} r 4: . •. rt f {''. F 1250 'G{+c1.LON 5Et?TIG T1NIG a' r" " }� ;., , 5-12 I I AkL''`�ETz DF .17,; 'iR>;NGH 1:� *M I. ' ,'2S' R4B �ILLt} tt k ' ' a --i tl g r :z 4 a PIT W/ PUMP:{ . :; G 1 1. f 1y ` il'r.Z'r ! x3 +� i r I W r 1 A } � _ `Y ; ., 4 1 .. I. 1 ! 1 r } '.t" 9-q { '.tvfii 1 !d v ' t _j...� f It. �, t, 1. - , ", a , T .i r1 ?4 t� r i NV 1 K h� ' wt a s 7 .t Y Yil �L, Lr �` 1 %. ;.� a i ,4 l H ;, �p l '�'n t,3 % rr �. '� ! r t !A. r 1 t 1. ,, 1# Nt M, t 1' . i f oI ! ; r t W Zx i t l$ ,. ,; '.1. t i� iv. -`wt` .r'Tr r - t a ti t �,F y! t r, I 1.. 7_ y Y �.. 3 t >,r. v ,! }.y ,;; p i o ei 1 k t lid M r i wS h r iac- ? T L J t i .3. E, a , s$, d 'Ti 71 ti Won !7 RM gut My VA A slow,,. who' I W "I SAM . . A .............. . . . . . . . . . .... fr opt up �yox SIC 71 ti Won !7 RM gut My VA A slow,,. A IPTWZ�& opt .311-11RUM Z "TOR G76 N a ft lot 37= - A �z its Iq Awl yn & - I cq - - .1 -. ., I INS:. AW, opt -howl-- AW,