HomeMy WebLinkAbout0371DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
13. -2 -84
BOX 5
1 y .
II
61
IN
L. T
NO
i �'rr , r. IF
'L - 8
16 C
A l 1
+ ' 1 , ;� -
PUTNAM COUNTY DEPARTMENT OF HEALTH
� DYVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWA T SYSTEM
PCHD CONSTRUCTION PERMIT # 60- �Located at A r'G, je'. e14 Nr Q g l V C Town or Village /L.
Owner /Applicant Name ,(���, 46 %')& Tax Map Block Z Lot
Formerly C Sub'
ubdivision Name 09�4-C9 s4cot t r
Mailing Address
Subd. Lot # 3
e
Zip 6-4,
Date Construction Permit Issued by PCHD / Z 7,5 / 7 5 Gj 10
Separate Se®vera ystem built by l�%D A� DA- S%� Address $41 -r PO/A/7- 12S 7g
Consisting of lL� Gallon Septic Tank and �0 4,1,4J, �r
Z y -7-R PAX 14
Other Requirements:_
91 m AAy e ' F-)( PAS 1o&)
Water Sup"I : Public Supply From
ore Private Supply Drilled by 1/D A.SI" WILL �,
Address
Address SZ _
Building Type f�,5 + or- '\M P(L— Has erosion control been completed?
'Number of 'Bedrooms 4 Has garbage grinder been installed?
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulatio of the Putn County Department of Health.
Date: ZZ- DO Certified by �� P.E.
(Design P o sional)
Address �?l�, �b� l�E1Uf?1�, l�• j i1� License # %'tj� .3.�
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are 'subject to modification or change when, in the judgment of the Public Health Director, such
revocatio m dificatio r change is necessary.
By: Title: Date: `j b7i
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
__l
H, DEP
4 55
R6W (9
iymedlov-
-
�
v
`
m
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
Albert H. Padovani, Director
LAB #: 93.'001663 CLIENT #: 12608
DELASTRO, ANGELO
22 RIDGE VIEW DR..
R&TTERSON, MY 12563
SAMPLING SITE: 22 RIDGE VIEW BR"
. : PATTERS8N, NY, 12563
C8L'D BY: ANGELO DELAGTRO -
NOTES...: KIT TAP�
DATE FLAB PROCEDURE
NON STAT PROC PAGE 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE/TIME TAKEN: 09/08/00 12:00P
DATE/TIME REC'D: 09/08/00 12:30P
REPORT DATE: 10/10/00
PHONE: (914)~878-2631
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..: < 4C-
COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RESULT NORMAL - RANGE METHOD
PUTNAM CNTY
PROFILE
09/08/00
MF T. COLIFORM
PRESMT
/100 ML
ABSENT
1008
09/08/00
LEAD (IMS)
<1
ppb
0-15 ppb
9101
09/08/00
NITRATE NITROG
1.11
MG/L
0 - 10
9139
09/08/00
NITRITE NITR8G
<0.01
MG/L
N/A
9146
09/08/00
IRON (Fe)
{0.060
MG/L
0-0.3 mg/l
2037
09/08/00
MANGANESE (Mn)
0.090
MG/L
0-0"3 mg/1
2037
09/68/00
SODIUM (Na)
90.8
MG/L '
N/A
09/08/00
pH
6.8
UNITS
6.5-8.5
9043
09/08/00
HARnNESGvTOTAL
268
MG/L
N/A
09/08/00
ALKALINITY �(AS
432
'G/L
N/A
()9/08/08
TURBIDITY (TUR
<1
NT[}
0-5'NTU
09/08/00
E. COLI (CONFI
ABSENT
100/ML
ABSENT
BACT
�HE
SATISFACTORY SANITARY QUALITY
ACCORDI.NG.--TO
RK STATE
AND EPA FEDERAL DRINKING WATER
STANDARDSq, FOR THE
PARAMETERS
TESTED., AT
THE TIME OF COLLECTION.
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 ppb and a COPPER value of 1.3 mg/L, else water
treatment must be undertaken to reduce the waters corrosive
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. Euuggested-guidelioes 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
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
' Albert H. Padovani, Director
LAB #: 93,001663 CLIENT #: 12808 NON STAT PROC PAGE 2
~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
uELeS/xu, AmmELu DATE/TIME TAKEN: {)9y08y00 12:0OP
|
22 RIDGE VD ���DR.� DATE/TIME REC'D: 09/08/00 12:30P
PATTERGON, NY 12583 REPORTQATE: 10/10/00
' PHONE: (914)-878-2631
' .
SAMPLING SITE: VIEW DR. SAMPLE TYPE..: POTABLE
� : TERSON' NY, 12563 PRESERVATIVES: NONE
C8L'D BEL8 QELASTR8 � ' TEMPERATURE..: < 4C
.
NO ES... ^
~- [AP ' C8LIFORM METH: MF
.~°~~~~~~~~~~~~~~~~ ~~~-~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~~~~~~
DATE --.,..FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
'
is suggested.
�
pH pH SCALE %N WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS 6.5 T8 8.5.
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE
HARDNESS MAY RANGE FROM 0 T8 HUNDREDS OF MG/[, �EPENDS ON THE
SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0-10 MG/L . VERY HARD WATER: ABOVE 300 MG/L
MODERATELY'HARD WATER: 70-140 MG/L ' Mb/L = MILLIGRAM PER LITER
HARD WATER: :140-300 MG/L ' <1 grain/gallon = 17.2 MG/L)
SUBMITTED BY:
Albert H. Padovani, M.T.(ASCP)
Director
ELAP# 10323
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800
Albert H. Padovani, Director `
LAB #: 93.001903. CLIENT #: 12682 NON STAT PROC PAGE 1
DELUSTRO DONNA
, DATE/TIME TAKEN: 09/29/00 08:30A
22 RIDGE VIEW DR. DATE/TIMEREC'D: 09/29/00 10:00A,
PATTERSON, NY 12563 REPORT DATE: 10/05/00
PHONE: (914)-878-2631
SAMPLING SITE: 22 RIDGE VIEW DR. ' SAMPLE TYPE..: POTABLE
: PRESERVATIVES: NONE
COL'D BY: DONNA DELUSTRO
^ TEMPERATURE..: < 4C
NOTES...: KIT TAP COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCEDURE R� ESULT NORMAL -.RANGE METHOD
09/29/00 MF T. COLIFORM ABSENT /100 ML ABSENT 1008
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATER. AS NOT) OF A
.SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE
AND IPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS,
TESTED, AT THE TIME OF COLLECTION. .
SUBMITTED BY:
ELAP# 10323
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address:
�Z 6,CI CV
Town/Village:
Tax Grid #
Map /3 Block Lot(s) Y41
Well Owner:
13
Name: Orge io bo osOz 44;Nore Address:
1' cdern Cerlte,– RVA Sn_:1- 0i.1 -r N14 125le
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion —)<— Compressed air percussion Other (specify)
Well Type
Screened Open end casing Open hole in bedrock Other
Casing Details
Total length 3i ft.
Length below gradep ft.
Diameter _(min.
Weight per foot �' lb /ft.
Materials: XSteel _ Plastic _ Other
Joints: _Welded �( Threaded _Other
Seal: X Cement grout _ Bentonite Other
•
Drive shoe: Yes No
Liner _ Yes No
Screen Details
Diameter (in)
Slot Size
Length(ft)
I Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
p
Well Yield Test
_ Bailed _ Pumped X_ Compressed Air
Hoursf
Yield 26 gpm
Depth Data
Measure from land surface- static (specify ft)
i6
During yield test(ft)
Depth'of completed well in feet
�o
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
q
lzm
Zime csimel-
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
o
Date Well Completed
Z
Putnam County Certification No.
Date of Report
n
Well rille (signature)
NOT9: Exact location of well with distances to at least two permanent landmarks to be provide on a separate sheet/plan.
Well Driller's Name i OEW �''► . Address: �1�5�( S2. �tr' C'-/ N V /dS' /L
Signature: Date:
White copy: File; Yellow copy - Building Inspector; Pink copy - Owner; Ora copy -Well driller
Form WC -97
-
MIMI
ka
Lot
OAT ymb
. ! �.7 1 " : A
!I ail
shm
eras
grotto Xon
owl
Was AVY
Ki
AS
--
--
- r
i
� 1 N
�
}
�•k '
Y
C
a
tj
3 ?
^axis
{ .C"1
�n 'fit. • ` x•�
S:
'' --t
1 -
"•Y
y
g
S'
J• � '; i 5
mac, .S
f
1
{ x
a1n
I >�
a �
R
K r
y�
d s
y •
4
i
� 1 N
�
}
�•k '
Y
C
a
tj
a1n
I >�
a �
R
K r
y�
d s
I
y •
i
� 1 N
�
3 �
a
tj
'' --t
1 -
"•Y
y
g
f
1
{ x
I
y •
i
c
�
3 �
a
tj
'' --t
1 -
"•Y
y
f
1
{ x
et
i
t• F 3r
-
I
y •
i
X"
3 �
a
tj
I
- 1•
E V
y •
i
a
tj
- 1•
E V
y •
a
tj
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address
Town/Village
Tax Grid #
MapwBlock
Well Owner:
Name Address
Use of Well:
1- primary
2- secondary
tion"�
Residential Public Supply Air cond/heat pump 'ITrga` " ""
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 X Open hole in bedrock Other
Casing Details
Total length ' ft. '
Length below grade �L`ft.
Diameter (0 in.
Weight per foot :I Ib /ft.
Materials: X Steel _ Plastic _ Other
1
Joints: _ Welded Threaded _ Other
Seal: Cement grout _ Bentonite Oth
Drive shoe: Yes No
Liner: Y s No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to S (ft)
eveloped?
First
Yes No
ours
Second
Well Yield Test
_Bayled�Pump'dlC pressedkAir
-
Hours
s. emu:
Yieldgpm
Depth Data
Measure from land surface-static (specify ft)
During yield test(ft)
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
X-60
rGy e
U
, 50_=�
w_Y��e
-1
-� mm
nff
'x___;•11..
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
Putnam County Certification No.- .
D�2 3
Date of Report
ri
Well Driller (signature)
NOTE: Exact location of well with distances to at least two n permanent landmarks to be providlsn a sepaaratesrevpta�n.
Well Driller's Name W Address. � � Camel, W , 1051
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address: vidic Vie—
Town/Village:
Rdt _1</- 1
Tax Grid #
Map Block Lot(s)
Well Owner:
Name: Address: Y
,fYl n C.Si n I Cc^4 --e.r- _Pdint ZS
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion .Compressed air percussion Other (specify)
Well Type.
Screened Open end casing Open hole in bedrock Other
Casing.Details
Total length eft.
Length below grade 30 ft.
Diameter in.
Weight per foot _(`9 lb /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 x Compressed Air
Hours IW
Yield ZC) gpm
Depth Data
Measure from land surface- static (specify ft).
During yield test(ft)
Depth of completed well in feet
Well Log
If more detailed
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
20 ,,
Date Well Completed
Putnam County Certification No.
Date of Report
Well Drille •(signature)
NOTE: Exact location of well wttn citstances to at least two permanent lanamarxs to De provta n a separate �rteevptan.
�- 5_z
Well Driller's Name �' (co", Loo � � Address: ►n2Q /US 12
Signature: Date:
White copy: File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller
Form WC -97
11/13/2000 16:39 04
STAPLES PAGE 02/02
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building
11'1ojea,o De sij_,,,3
Building Constructed by
a,. QCIjie y /ew
Location - Street
Tax Map Block Lot
TownNillage �^
R/d S e �l f h9 }es
Subdivision Name
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 nee 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: M on th _ Da y � Xe ar i 1 � � Si gn ature:
Title: 0 ( r 0f e
General Contractor (Owner) - Signature
Corporation Name (if corporation) Corporation Name (if corporation)
Address: Address: Lh Mal k. S W
State zip State zips 6 0
Form GS -97
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 -.7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Sean J. Daly
P.O. Box 243
Shenrock NY 10587
Dear Mr. Daly:
November 14, 2000
Re: Proposed Compliance: Delastro /O'Hara
22 Ridge View Drive, Lot #39
(T) Patterson, TM# 13 -2 -84
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:
1) The Well Completion Report has not been filled completely and has been revised e.g.,
a) The road name has been changed.
b) The Well completion Report has not been dated.by the well driller.
d) Well owners name "Modern Design" is not the same name that is on the
Construction Permit or Certificate of Construction Compliance.
2) The SSTS Guarantee has not been submitted.
Upon receipt' of a submission, revised to reflect the above comments, this application will be
considered further.
Very truly yours,
Robert Morris, P.E.
RM:tn Senior Public Health Engineer
A
FAX:911424�3170, L
THU f) 5 r4 PM,
Yr"L ENVIROMIENTAL SERVICES
321 �-,lear- street
Fleinhts . N. Y. 1059R-
(914) 24'15-a&:*
H. Fadzivani. Director
LAB #u, 9S-('-)0!q()3 J-'LT-!:!%JT '1266r-
JON STAT PROC PAQE
I) EL! STRO, DONNA
ac"21 VIEW DR, DATE/TIVIE 09/101zz'00 1():0i)A
F-ATTERSON, NY I tE 3 REPORT DATE:
PHONE: (914)-L978-2631
SA1' PLINQ3 SITF-7: 22 RIDOE VIEW SAMPI.E TYPE—; POTABLE
F'R�,SERVATIVE,63-. NONE
COLD ZY: DONNA DF;-LU8TPr.J T'EMPERATURE..: -:" 4C
NOTE'. Kl'r TAP COLIFORM ME' H: ME=
-------------------------- -----------------------------
DATE 5LAQ PROCET'URE
R E IS U J'-T NORMAL, - RANGE M ET H 0 L.)
09/89/("o m= T... "FmLIFORM Af-!SFNT /100 ML AKUNT
COMMENTS:
f-'-AXED TO (719) X142-47!59 ..... RE-PIkINTED
COMMENTS-.
I-'-%A('T THESE. RESULTS INDICATE THAT THE WATER ( (WAS (WA NCT 7 0F` A
aATISFACTOF�Y GANITARY 111JALITY ACCORDTN, THE NEW YORP" STATE
AND EFA PE`_QE'r,*,Al- CRlNk,",lNCB WATER STANDARDS. r.QP% THE PARArIET-RS
TESTLD, AT THE -I'APYIE OF COLLECTION.
SM8MITTE"'D
-Albert.'F'q, Y..'adrpvahi, M.T.(ASCP).
Director
1f)08.
El-.(-)F'# 10323
t T -10 -00 TUE 04:39 PM YML FAX;9142453170 PAQE 1
. YML ENVIRONMENTAL SERVICES
321 Kesar Street ; -
Yorktown Heights. N.Y. 10598
(914) 245--2500
Albert H. Padovani. Director
LAS #t 9a.001663 CLIENT #: 12608 NON STAT PROC PAGE 1
DEL.ASTRO, ANGELO
22 MIDGE VIEW DR.
PATTERSON, NY 12563
SAMPLING SITE: 22 RIDGE VIEW DR.
: PATTFRSON, NY, 12363
COLD &Y: ANGELA DELASTRO
NOTES...: KIT TAP
IYNNN tyro NNMNNNNroryNNY wiNNIYw NNNN NNN NN NNN'wryryN
DATE FLAG PROCEDURE
DATE /TIME TAKEN; 09/06/00 12 :00.P
DATE /TIME REC °D: 09/08/00 12:30P
REPORT DATE: 10/10/00
PHONE: (914)-878-2631
SAMPLE_' TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..: < 4C
COLIt=ORM METH: MF
NNNNNN/.NroN MNNNNNNA�NN NNNNN NN NNNN M1roroN Nw1YN
RESULT NORMAL. - RANGE METHOD
PUTNAM CNTY
PROFILE
09/08/00
MF T. COL I FORM
PRE=SNT
/ 100 ML,
ASSENT
lobe
09/08/00
LEAD (IMS)'
r1
ppb
0 -15 ppb
9101
09/08/00
NITRATE NITROG
1.11
MG /L
O - 10
913a
019/08/00
NITFITE NITROG
:0.01
MG /L
NIA
9146
09/08/00
IRON (Fe)
<0.060
MG /L
0.0.3 mg /1
2037
09/08100
MANGANESE 01n)
0.090
MG /L
0--0.3 mg/1
5037
09/08100
SODIUM (Na)
90.8
MG /L
N/A
09/08/00
pH
6.8
UNITS
6.5 -8.5
9043
09/08/00
HARDNESS, TOTAL,
MG /L,
N/A
09/08/00
ALKALINITY (AS
4332
MG /L
N/A
09/08/00
TURPIDITY (TUR
<1
NTU
0 -5 NTU
09/09/00
E. COL I (CONF I
ABSENT
100 /ML
A33SENT
COMMENTS: .
_
SAC:T THESE RESULTS INDICATE THAT THE WATER
(WAS).
Off' A
SATISFACTORY SANITARY QUALITY
ACCORDING TO TH
STATE
AND EPA FEDERAL DRINKING WATER
STANDARDS, FOR THE
PARAMETERS
TESTED, AT
THE TIME OF COLLECTION.
Pb /Cu LEAD limits for p+
EPA head & Copper
than, 10% of their
than 15 ppb and a
treatment must . be
potential.
iblic schools are set at 15 ppb.
Rule for Public Systems requires that.no more
distribution points have a LEAD value of more
COPPER value of 1.3 mg/L, else water
undertaken to reduce the waters corrosive
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 80 mg /L of Sodium. For these on a
moderately restricted diet, a maximum of 270 mg /L of Sodium
civT 10-00 TUE 04:40 FM YML FAX:914245'3170 PAGE 2
YML ENVIRONMENTAL SERVICES
321 Kear Street.
Yorktown Heights, N.Y. 10598
(914) 245 -2800
Albert H. Padovani, Director
LTAS #: 93.001663 CLIENT #: 12608 NON STAT PROC PAGE 2
-------------------------------- - NNNN.VNNNNNA/N----- ryNNNNN- h W NNNNNN NNIVN/vNN
DELASTRO, ANGELO DATE /TIME TAKEN: 09/08/00 12:60P
22 RIDGE VIEW DR. DATE /TIME REC'D: 09/08/00 12:30P
PATYERSON, NY 12563 REPORT DATE: 10/10/00
PHONE,,: (514) -879 -2631
SAMPLING SITE: 22.RIDGE VIEW DR. SAMPLE TYPE..: POTABLE
: PATTERSON, NY, In63 PRESERVATIVES: NONE
COL.' D BY: ANGELO DELASTRO TEMPERATURE ..: 4 GEC
NOTES KIT TAR' COL I FORM METH: MF
NNNN NNNNNIVN------ NNryhryNIV ---- /ry-N - ----NI ------ ---- -- rNYVNNN ---- ryryN
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
is suggested.
PH pH SCALE IN "WATER RANGES FROM 1-°14. MEASUREMENT OF pH IS ONE OF
'rigE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT 8E CORROSIVE TO METAL PIPES AND
FIXTURES. THE NORMAL RANGE OF pH 15 6.5 TO 8.5.
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM L MAGNESIUM
CONCENTRATION, BOTH EXPRESSED AS CALCIUM-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)
SUBMITTED BY:
Albert H.- Padcvani. M.T.(ASC:P)
Director
FLAP# 10322
V i
1
BRUCE R FOLEY
Public Health Director
Sean J. Daly
P.O. Box 243
Shenorock NY
Dear Mr. Daly:
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
�rtS L
LORETTA MOLINARI: R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
10587
Re: , Proposed SSTS: Delustro
Ridge View Drive, Lot #39
(T) Patterson, TM# 13 -2 -84
April 11, 2000
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:
1) SSTS Guarantee has not been fully completed. (Enclosed).
2) Original Well Log has not been submitted. Photocopies are not acceptable.
3) Water analysis for iron exceeds State standards.
Upon receipt of a submission, revised to reflect the above comments, this application will be
consider further.
Ve ly yours,.
r
Robert Morris, P.E.
RM :tn Senior Public Health Engineer
enc.
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental •Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914)278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
E911 ADDRESS VERIFICATION FOR
l
OWNERS NAME: A�D J;bA1 /VA DbZ-0_571,0
TAX MAP NUMBER: Z - 93 A
E911 ADDRESS: Z e 2 ei_ Vzovi b ✓a
^A- 4`7 A-1 1J TOWN:
AUTHORIZED TOWN OFFICIAL:
(Signature) /
DATE:
e
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is assigned by an authorized town official. This form is to be submitted
with the application for a Certificate of Construction Compliance.
(E911 VERFRlv1)
PUTNA I COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES l
FINAL SITE INSPECTION
Date: &2-219 9
Inspecte y: �;, kee,,4
Street Location 17�G Owner Q �2,� i �
Town rf�q�/'67�Sa�/ Permit # - - �Q-- f.3
TM # /- - X2 —6y Subdivision Lot # _j-7
1. Sewage System Area
a. STS area located as per approved plans ...........................
b. Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth
c. Natural soil not stripped .............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 100' from water course / wetlands ...... ...............................
II. Sewage System'
a. Septic tank size 1,000 ..... .. 1, 250.......other ................
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Distribution Box
All out ets 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
1. Length required n o Length installed oe)
2. Distance to watercourse measured 4- 20OFt..........
3. Inst d rding an. ... ................................
4. Sl f y h la e tale /16 - 1/32 /foot .............
5. 10 ft. from property line - 20 ft.- foundations..........
6. De
7 R o d. r e .....e.
o ...
.................
8. Si e
9. Depth of gravel in trench 12" minimum ...................
10. Pipe ends capped ........................ ...............................
g. Pump or Dosed Systems
1. Size ot pump c am er ................ ...............................
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. HouseBuildin '
a. Rouse located per approved plans ... ...............................
b. Number of bedrooms ............ ...............................
IV. 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 box4 �j.6 Ad..by..-S!f m l
d. Backfill material contains stones <4" diameter .............. l
e. Curtain drain & standpipes installed according to plan..
f. Curtain drain outfall protected & dinto exist watercoursf
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ... ...............................
i. Erosion control provided ................. ...............................
Rev. 6/97
orm -J
�n
slrr
YES
NO
COMMF;N I N
oC
k
X
x
7-o r; e % ✓15 f c. � � r r,
x
k"
orm -J
�n
slrr
p"' in :good -operatins-condition any _ part,,ol - aid. :fawsga dISpoml :systern during,jhe PwJO4.OT.lw0 (Z I YWS4MffIROWITIy.TRI?R4!FInV �nllgale qTAnG #WIU-
since At Im
ilik Ili lac!
County bi
Clete
APPROVE
7
Signed
License
e
7";dl
ilz he
. It
CONSTRUCTION. I isgii uniess. can '!14 been undertaken, and is
Orr 'A im
cause or frnadmili'*14n, r ornmiisioner of'Health. ny,chango or alter n of construction
njit..:rporojIM for 4i'spon(al, darn ry saw ri --le water. supply only.
Title
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
please print or type PCHD Permit #
Well Location:
Street Address: Town/Village Tax Grid #
( o& e, v ( bl mtt"d Map l'�- Block -2-- Lot(s) 8-y
Well Owner:
Name:
A ess:
I I
0 A'f A
-0 - go /- ?-$ Z--
U 11:
esidential Public Supply Air /Cond/Heat Pump Irrigation
I -prima
Business Farm Test/Monitoring Other (specify)
-secondary
Industrial Institutional Standby
Amount of Use
Yield Sought �5 gpm # People Served r Est. of Daily Usage 130D gal.
Reason for
ReDlace 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 No
Is well located in a realty subdivision? .... ............................ ............................... Yes ✓No
Name of subdivision t4,4 I A Lot No.
Water Well Contractor: 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: '7 l iM L
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date: t 2-12-3 149 Applicant Signature:
PERMIT TO CONSTRUCT A WATER WE(Z
This permit to construct one water well as set forth above, is granted under 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 ller certified by Putnam
County.
Date of Issue 2. A Permit
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
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: O'Hara
Ridge View Drive, Lot #39
(T) Patterson, TM# 13 -2 -84
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."
I) Proposed contours are to be shown.
2) Current codes requires that fill is placed is the expansion area.
3) Trench detail is not correct. Minimum'distance from the bottom of the trench
to ledge is 5 feet and to water is 4 feet. Revise accordingly.
Upon receipt of a submission, revised to reflect the above, this application will be considered further.
Ve truly yours,
Robert Morris, P. E.
Public Health Engineer
RM:tn
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of
Located at 2,,26E ["i,EVcl
/ T%-'4- el
(T) �.¢ /���S�N Seeti: 13 Block 7i Lot 8
Subdivision of
Subdv. Lot # Filed Map # Z 3 (f C) t3 Date
Gentlemen:
This letter is to authorize ���/ Tri56P./ ,ysr1jl
a duly licensed professional engineer Z---or
(Indicate
to apply for a Construction P�ermit.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:
P.E. , R.A. , # 7 !� 35
Address
76 57 773
Telephone
Ownert of Property
Address
Town -
e„ %c -r 7
s�c�
Telephone
�ll
62
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
BRUCE R. FOLEY
Acting Public Health Director
Sean Daly Tel. (914) 278 - 6130 Fax (914) 278 - 7921 November 3, 1997
Box 243
Shenorock, New York 10587
Re: Proposed SSDS: O'Hara
Lot 39
(T) Patterson
Dear Mr. Daly:
Review of plans and other supporting documents submitted at this time relative to the above -
captioned project has been completed. Comments are offered as follows:
"The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in this regard."
1/1) Engineer's authorization has not been signed by the property owner.
✓2) Trench cover is to be noted as geotextile.
Q` ✓3) Erosion control measures are to be shown and detailed for the house well and SSDS.
2 ' JFurthermore, 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,
✓5) 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,
& gow
Robert Morris, P. E.
Public Health Engineer
RN1/mh
watershed
NELL
r r�rvt/..t�UKT =UTTUM
FABRIC,
i `� Y 4TAMP IN PLACE.
IO i Y•t 9 t Mom
4.. PVG TO BE NOTE:
5LEEVED.. IN ALL` Ef
dp
1:250 6AL
MA5ONRllr
SEPTIC
T TANK
f
x
h ij r
r,v♦��♦
. ♦1 ■ '! ♦ ♦b ♦ ♦ ♦ ♦ ♦.♦b ♦ +�_ y� • .� t� ice€
���♦ �o `� "\\, it r:�.�• -`'�� �' � •• `��"':
�y_
jai �i�W uk; '•� /:/ �� - '�;
Shawn Daly
P.O. Box 412
Shenorock NY 10587
Dear Mr. Daly:
CO
a �
DEPARTMENT OF HEALTH
Division of Environmental Health Services
.4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
December 1, 1998
Re: Proposed SSTS: O'Hara
Ridge View Drive, Lot #39
(T) Patterson, TM# 13 -2 -84
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) Minimum of two feet of fill is to be shown in the primary and expansion
SSTS areas. Fill is to extend 10 feet horizontally past the edge of the trench
and then slope 3:1 to grade. Proposed contours do not reflect this
requirement. It may be advisable that the proposed well is relocated towards
the back property line. This would allow the SSTS to be shifted back from
the road, resulting in the proposal of the SSTS on less complex topography.
It is your responsibility as the design engineer to determine in the well could
be proposed in a different location.
Upon receipt of a submission, revised to reflect that above comments, this application will be
considered further.
truly yours
Robert Morris, P.E.
RM:tn Public Health Engineer
N6mhw d Bt±ttilde�a Deaip Fbw G P D .CXJ .. PCHD NotlSatlod 4 Ye4a4ed Whein I+fl� b ootapidsd
Slip¢tla Seweaa�e Srgta a rea�alat si .Bw Saptle Took
Ti be oa�ahs.ead b� '
,777777:11
Add
Waal SII�¢. PabYe S�pttb Prali` Adler
t'
5 i
,
1:�ep►eant tMt 1 am wholly ana compNtaly ntponsiblefor tM desgn antl location of fha proposal system(s); 11 tMt tM.wparatrfaw di.
lipo
vl Rem
allow dacnlNO will W constructal of shown on t11s approw0 amendment theM to aid, in accoritana with the stan"Fas, rules a .reyu ns o n
County Depattrniit ?of, ,Meellth;
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 A
ress
o Village City Tax Grid Numbe
j.
WELL OWNER
Name
Mailing Addre
CWrivate
O Public, .
USE OF WELL
1 - primary
- secondary
SIDENTIAL
0 BUSINESS
0 INDUSTRIAL
❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL ❑ STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT gpm/#
L] REPLACE EXISTING SUPPLY
e<EW AUPPLY NEW DWELLING )
PEOPLE SERVED & /EST. OF DAILY USAGE CO) Sal
❑ TEST/ OBSERVATION L1 ADDITIONAL SUPPLY
O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
ODRIVEN
aDUG GRAVEL.
0 OTHER,
IS WELL SITE SUBJECT TO FLOODING? YES �r0
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC MATER 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 contaminate surface or groundwater.
Date of Issuer
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
LOT 39 , LV11•uV -1 QCXJ141Y DUAR11 -IL• U UP III- A1,111
SECT ION 2 DIVISION 0V DWIMY•1L• ML, 11EAU111 SE31VICES
DIZIGN Uf1TA SILECr- SU13SUTACC SEWAGE DISPOSAL SYSLIN FILE NO.
t
00mer _ PETER O'HARA Address P.O. BOX 282, PATTERSON, NY
LocaLed at (Street) ROUTE 311/CROSS ROAD Sec. 10 Block 2 Lot 1 1
( indicate. nearest cross street)
Municipality PATTERSON Watershed CgOTON
SOM PERCOLATICN TEST DAM RDQUIRED TO BE SUBMITTED IfMI APPLICATIONS
Date of Pre - Soaking 9/16/88
Date of Percolation Test
9/16/88
UOLE
Nt]<•l M CLOCK TIME
PERCOLUION
PERCOLATIM
Run Elapse
Depth to Water From
Water Level
No. TILm
Ground Surface
In Inches
Soil Rate
Start-Stop Min.
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
11 1 1:29 -1:36 7 24 27 3 2.33
2 1:37 -1:46 10 24 27 3 3.33
3 1:47 -1:57 10 .24 27 3 3.33
4
S .
2) 111:14-11:20 6 24 27 .3 2
2 11:21 -11:27 6 24 27 3 2
311:27 -11:33 6 24 27 3 2
4
_ f
rs�
2 V -' u /IT '/!� rI {l
3
•<14.
1: V
I= A I-
"1
W v 0�•
1101'E:;: 1. Tests to be repc.-ited' at came deptli unti1 approximatel.Y agt'.-I co il rates
are obtainai .at each percolation test Isle. All data to* tr sulrnittbd
for revier.
2. Depth measurate' n •; to ba- made Fran top cal hale.
rev. 9/05
4
1)I:��111
c:. 1..
611
12"
113"
24"
30"
36"
42"
48"
54"
60"
66"
72"
78"
O'HARA SUBDIVISION
'1 -mr rrr UNrA IiUJUIRD) '10 UL•' SU11.11.1'1'L'U 111.111 A1'1'1,1(:Wr1.011 SECTION 2
UL:SU 11'r1UN OL L OMZ E140UUN1'LAUM IN 'rEsr Hulm
IULC 1,10. 3 9 A
TOPSOIL
BROWN
SANDY
LOAM
ROCK 0 5 ft.
IIOLC 140.
TOPSOIL
BROWN
SANDY
LOAM
W /SILT
1 IULC W. .
Rock 0 6 ft. ;
111DICATE LEVEL A!T Sn IMI Cam( WWATI•A IS None
111DICAIE LEVCL To mat WATER LEVEE, RLSES AFTER BEING FZtJYJHTEM N/A
DEEP IIOL£ ODSMMTIONS I.ME BY s J.F. E BE RL E DATI;s 9/6/88
_ _ .. � IK•!CT[�J A�> f
Soil Hate Used 7 ( 3.3 3 )HLn/l" . Drop: S.O. Usable Area Provid
11o. of Iledroct, 4 Septic Tank Capacity gals
Absorption Area Provided Sy 400 L.F. x 24" width trends
Wier ft _ fill rPeuired t:A
lbm OAM)WIN & CORNELIUS, P.C. Signature PM
Address RD 5., Route 22 SEAL =°0 1980 A '
• • Thews ter . New York 10509 afw r °�`•� • o' �s, :�
iu><S spncc Eutt use t1Y itrAmu DEPAtmim1r ONLY: " ........."
' . £Oil hate Approved' sq.ft/gal. Checked by Dale
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property of
FA-
Date 1 l t iii 1 � -t)
Located at��p�`�iE�i -1!�
1,A'
C. Pe bi Block 1_4.0 t Q-
Subdivision of �A A `
r '• � . Date. � •
Subdv. Lot # Filed Map #
T. MICHAEL DALY; P.E.
Gentlemen: CONSULTING ENGINEER *•
P. 0. BOX 243
This letter is to authorize SHENOROCK N X 10587
a duly licensed professional engineer or registerP ^h�*���t
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rule-s
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 constructign of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and'th,e Putnam County Sani-
tary Code.
Very truly yours,
ned r
Countersign i Owner of Property
/L
P.E., R.A., # `Z Address
T. MICHAEL DALY, P.E. , �c�'t-+-C C--, o
Address Town
1. F. U. BOX 243
SHENOROCI , N. Y. 10587
Telephone
9y7�-- -7 s 2 -`i
Telephone
YU -1
P U T N A M COUNTY D E PA RT M EN T O F HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1.. Name and Address' of Applicant:
�Zy�l 17- (e
jj
2. Name of Project: , 3. Location4JVV /C: ��►T1't�,,,1
4. Project Engineer: 5. Address: WOK
License Number: Phone: —O SU-
6. Type 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?
1
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;..io6ing,
or other officials, ordinances? ........................................... 2 LD
12. If so, have plans been submitted to such authorities? ^� 6
13. Has preliminary approval been granted by such authorities? Date Granted:
14. Type of Sewage Disposal System Discharge.l� ': >-/>�, Surface Water Ground Waters
15.
If
surface water discharge, what is the stream class designation ?.........
_
16.
Waters index number ( surface) ............ .........0.....................
17.
Is
located
project near a 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 ?.....
20. Name of sewage system Distance to sewage system
21. Date observed: 23. Name of Health Inspector:
24. Project design flow (gallons per day) .. ........ ....................
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
11
wetland ?...... ............................... N
28.' Wetland I'D Number ................ ................0.............. ...
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 appl:i'c... ibn
of pesticides to orchards or other crops, solid or hazardous waste disposal, +t
landfilling, sludge application or industrial activity? «..... YES o�, NO - N '
32. Is project located within 1,000 feet of existence o.f., "abandoned landfill,`
hazardous waste site, salt stockpile, landfill, sludge disposal site or ,.:.
any other potential known source of contamination? ........... .... YES. or, No
DESCRIBE:
33. Is there a local master plan or file with' the Town or Vil.l:age? .......
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 ............. ......................1:�? 72:7 .
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 reject ion'of. any submission.
I hereby affirm, under penalty of perjury, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant,- o Section 210.45 of
the Penal Law.
SIGNATURES & OFFICIAL TITLES:
MAILING ADDRESS: 7f5 X `7i4-; `TJ �01�0�� Q , Cif
.T. MICHAEL DALY E.
BOX 243 SHENOROCK, N.Y.
4 BEDROOM COLONIAL'
SINGLE FAMILY RESIDENCE
T.
mur?
Room
C, BATH
BATH ROOM
CL. GL. GL.
HALL
25
MA5TER
BDRM #2 BURM #5 BORM
1 Y EAT IN&
}--24
G AREA
, I C, :
5tA- TH N6
-ROO
- SECOND FLOOR
STUDY
LIVING :2
ROOM
FOYER
KITCHEN
FIRST FLOOR
:2
}--24
G AREA
, I C, :
5tA- TH N6
-ROO
- SECOND FLOOR
STUDY
LIVING :2
ROOM
FOYER
KITCHEN
FIRST FLOOR
I C E
\
510
N35'08'54 "c 15.0C
LOT 5!�
NO
WITHIN 100'
PROF
WELL
77.
CA
`�'�50� tom„ � -• L�-- (� '\ f i /4 "jF � .
7AN<
2" R.O.B.
FILL
)3,s.cc,
fl.2
I . Y
111\0k,
I
01
rn
0 +lb �.5�
7=
M 04M
d
Pam IFOR slirs DEPOSAL SYSTM
Swwldd=.N&w -SW6L I -a 0 T.
�F.
Townes
-Date. SiubdiVision� Appro Fee Einnlna , =-d'
Al
L;ot, Atoll - 0I ,
N"W ei Design Flow G P D -pM. N"O'Madon Is ReOubldWhis FM 6 emblegid
-77
Syvk6 to fted.lit d-_ GeDoa Serde Tmk -6111
T!k be'
Address
Fillies -Address;
o�-
S11110k, D*dbd
an,
Other -111 IS
reorlk", t4t!,ri wh6lli:a�q.ioololisteiy-i re" 'ig 'k 'ion ,o he ,,proposed "Systsm(s); that t1he dlij►84 4:14, stern
n e or-thtiies nand "t . i 0, - " - - -
above described will be constructed as shown on,the ,app(oved amendni the itandares. rules an regulations 91
County
��bjpjfthjenj '0- - L' ' - k. on "Ill"t" VMS..
-1 f ' HMRK'- and that thereof a. 46"ficiii, of'Cdniir,uctioni'i:6ri4ilan6--.iiiisisOo►y to the CoMmisalonspr of Hufthwill
be &4, Dipah"t. and., a'. rfil!OL,."irllntee:W- III be fu 'hak. -1, 1 .
rnished the "nor. - S - a
hIs� ft!cceeaors, $ ,b*6 the ku'l". that,"id. buildw will
Pike in pot eow0i*6 cls",ItIgn, any. Part, "a" 4 Mclul system iouili* the iod of tW6,(i year madiatel ollowl
Of -the apprielial -of 't he Cgirtificiltill Per fie the4site of the imu
C of th OF1411 y r above
Construction. amptlisnce, i*I9!n4! SY r o. that the drilled wall described
Proved Ion and thatriiid Well will be installed in a the -'GTE-
Coilinii"Dipertminif :P and reou As .,ol: the Putnam
oat.
• P.E. A.A.
'Licem
Aildre
se No 0
APPROVED, FOR i:bf�
ievoiabp '"' CONSTRUCTION: This'apfl!"J!l i!"N'two-years !r.orn the date issued unless of the building bass
f - ba4, L ' -1.1 1 1 - I I . I A undertaken and is
or.cause,ormay, ;amended Or modified : When considered n a missionr of Helh. Any charge or alteration of construction'
►eOuirN a- now P4vm1!P A PDrov el fou di donw '
Rev.
2,
Title
10/88 Tit
S.
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 &oA-3
WELL LOCATION
Street dress
To illage City Tax Grid Number
t_-S - d
WELL OWNER
Name
Mailing Address
04'fivate
O Public
USE OF WELL
primary
secondary
G-1 SIDENTIAL
0 BUSINESS
0 INDUSTRIAL
❑PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP
❑ FARM ❑ TEST /OBSERVATION
[]INSTITUTIONAL ❑ STAND -BY
OABANDONED
❑ OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT_ d gpm /# PEOPLE SERVED C9 /EST. OF DAILY USAGE 6d_j_gal
❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION ' GIADDITIONAL SUPPLY
RIMW SURLY EW WELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
DDIILLED
DRIVEN
ODUG
GRAVEL.
O
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES L""NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
�0 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.
J
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 c- amgSqTZ--su,�face or groundwater.
Date of Issue: �� 19
Date of Expiration 19 'Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller