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HomeMy WebLinkAbout0372DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -85 BOX 5 00181 No ON IN t . N. Ito I I, .T I ,{ ` I� I _ � 00181 q PTJ'I'NAM COUNTY DEPAit'I'NiEN1' OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # _3 Located at To r Village Owner /Applicant Name e T K �6+zai tyCg 6 ,ep, Tax Map %3 Block Z.- Lot .05— Formerly (:-)I la ASP- b Subdivision Name Subd. Lot #�' Mailing Address L Date Construction Permit Issued by PCHD 5-15 Zip 'o 7413 Separate Sewerage System built by EZ: ' K Address 7, -J:5 & L�. � � i✓J Consisting of �.Z Gallon Septic Tank and `j �t�> Lim, `� 1 . 2,v r 6 IP.Et')G Other Requirements: Water Supply Public Supply From Address or: V Private Supply Drilled by S': 4SCV}S Address N1A('LGQC-. ajU13a) Al Building Type 99S09&TONU Has erosion control been completed? �S Number of Bedrooms S- Has garbage grinder been installed? N e) 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 regulations of the Pu am Co ty epartment of Health. Date: ti u Certified by P.E. R.A. (Desi ofession;) Address 0 e o License # 7 7 b3 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals subject to modification or change when, in the judgment of the Public Health Director, such revocatio dificati or change is necessary. B y. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: �' (�, e Town/Village: BL7CkwAl Tax Grid # Map ;Z Block a Lot(s)FS Well Owner: Name: Address: 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 -1 Compressed air percussion Other (specify) Well Type Screened Open end casings Open hole in bedrock Other Casing Details Total length / ft.. Length below grade ft. Diameter min. Weight per foot �lb /ft. Materials: l-, Steel Plastic _ Other Joints: _ Welded- Threaded _ Other Seal: '%. Cement grout _ Bentonite Other Drive shoe: N,-.,Yes No _ Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped `� Compressed Air Hours (L 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 ,3 P1 IL 3 Q iilC.S N If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypeSu Capacity Depth 100 Model��iS�� Voltage o13D HP lam_ Tank Typ lKP[ L Volume U Date Well Co plete /A7ii Putnam County Certification No. Date of Report 99 Well riller signature NOTE: Exact location of well with distances to at least two perman ent landmarks to be provided on a separate sheet/plan. / r Well Driller's N e /2.. -S d NS Address: v Signature: Date;.5 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ' . ON eceik WP ru ^° ~ � m . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM I Owner or Pu- chaser of Building Building Constructed by Location - Street 1-3 21 Tax Map Block Lot. ow , illage 6IIA64 SvAP nIKi�- d Siam/ 2T Subdivision Name Building Type Subdivision Lot # I represent that 1I 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. ,a 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 J —Day// Year General Contra r (Owner) - Signature Corporation Name (if corporation) Address: L i „ lW2 2ZA- l State Zip Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM tin Owner or Purchaser of Building E TL &A % C�u� Building Constructed by Location - Street Building Type �J Tax Map Block Lot Town/Village 2 ►dcf-,uo uj Subdivision Name *� r_+0 Subdivision Lot # I represent that 'l am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director. of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month �5 Day Year 9 Signature: Title: V (fb Gener 1 Contractor (Owner) - Signature 71C U Corporation Name (if orpora ion) Address: Z 15 Va l k he � S Jim State rwi7. e, & I)d V N k P Corporation Name (if corporation) . Address: State Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street / Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Pa�ovani, Director LAB #: 93.903047 CLIENT #: 114 NON STAT PROC PAGE 1 TOR LISH & SONS DATE/TIME TAKEN: 04/15/99 09:30 BOX 271, 45 MAPLE AVE. DATE/TIME REC'D : 04/15/99 O9:40 ATTENTION: DWAYNE T RLISH REPORT DATE: 0-15 ppb 04/23/99 ARMONK, NY 10504 0.88 PHONE: (914)-273-3448 0 - 10 SAMPLING SITE: ETK BUILDING CORP : RIDGE VIEW RD PATTERSOM� COL'D BY: D. TORLISH ' ' NOTES...: TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE . SAMPLE TYPE..: POTABLE NY PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD COMMEN T'S : BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINE���~�'HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED: AT THE TIME OF COLLECTION. Pb /Cu LEAD 1imits fur public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points hav� a LEAD value of more than 1.5 ppb and a COPPER value of 1.3 mg/L, else water treatm�nt must be undertaken to reJuce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined sha ll not exceed 0.5 mg/L. No limits for Sodiu'm that for people on a contain no more than moderately restricte i td s sugge� e . are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a J diet, a maximum of 270 mg/1- of Sodium � PUTNAM CNTY PROFILE 04/15/99 MF T. COLlFORM ABSENT /100 ML ABSENT 1008 04/15/99 LEAD (IMS) <1 ppb 0-15 ppb 9 10 1 04/1 �/99 NITRATE NITROG 0.88 N /L 0 - 10 9139 04/151199 NITRITE NITROG <0.01 MG/L N/A 9146 04/15/99 IRON (Fe) 0.204 MIS /L 0-0.3 mg/1 2O37 0�/15/99 MANGANESE (Mn> 0.149 M /L 0-0.3 mg/l 2037 04/15/99 SO`IUM (N,) 2.24 MG/L N/A 04/15/99 pH 7.0 UNITS 6.5-8.5 9043 04/15/99 HARDNESS,TOTAL 174 MG/L N/A 04/15/99 ALKALINITY (AS 146 MG/L N/A 04/15/99 TURBIDITY (TUR 1.2 NTU J, -5 NTU COMMEN T'S : BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINE���~�'HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED: AT THE TIME OF COLLECTION. Pb /Cu LEAD 1imits fur public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points hav� a LEAD value of more than 1.5 ppb and a COPPER value of 1.3 mg/L, else water treatm�nt must be undertaken to reJuce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined sha ll not exceed 0.5 mg/L. No limits for Sodiu'm that for people on a contain no more than moderately restricte i td s sugge� e . are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a J diet, a maximum of 270 mg/1- of Sodium YML ENVIRONMENTAL`SERVICES 321 Kear Street Yorktown Heightsr N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 9~.903047 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CLIENT #: 114 NON STAT PROC ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PAGE 2 TORLISH & SONS DATE/TIME TAKEN: 04/15/99 09:30 BOX 271, 45 MAPLE AVE. DATE/TIME REC`D: 04/15/99 09:40 ATTENTION: DWAYNE TORLISH REPORT DATE: 04/23/99 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITE: ETK BUILDING CORP : RIDGE VIEW RD PATTERSON, COL'D BY: D. TORLISH NOTES...: TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE NY PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN 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 RANG-1,..:. OF on IS 6.5 TU 8.5. Hd TOTAL HARDNESS IS DEFINED AS 11-HE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, B[D'H EXpRESSED .AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREAT 'ENT TO WHICH THE.' WATDR HAS 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 MS/L (1 grain/gallon MG/L) SUBMITTED BY: ELAP# 10323 0 MU I.,., A O / (9� �. 2 i lq LU U .w �. Putnam County Department of Health Division of Environmental Health Servioes ` NNQ .0 Approved ae.noted for aonformanoe with Q . appl a e Rules and Regulations of the Co Health Departm 0 Signature A Title (Date YeLL FOX WOOD TERRACE LOT 40 i .13C AG ± SCALE I " = 20' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # y� Located at > 6f 111E A/ P41 i/ r �� Town o Village ,,�TT��S V Subdivision name " ' R4 Sub Lot # Tax Map Block G.- Lot �y Date Subdivision Approved Z Z Renewal Revision Owner /Applicant Name 4Tx , ,c,;7 „tJl g��X'p . Date of Previ/us Approval J ' Mailing Address 15 VA-I L 1 AJa A�r I H SALT. -, Ll y Zip Amount of Fee Enclosed Building Type 12ALLot Area 1 No. of Bedrooms Design Flow GPD 56�v &'rtes 7 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /Z.S'� gallon septic tank and � ew/ Z- ���� ?W >' 0 Other Requirements: To be constructed by I -- f2 D Address Water Supply: Public Supply From Address or: nvate 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. License # Dat z2�16 APPROVED FOR CONSTRUCTION This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh co sidered nece by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t, A oved for s arge of domestic sanitary sewage only. J By: Title: (J— Date: l6 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -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 (9 14)278-6130 Fax (914) 278-7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 —6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 MEMO To: All Design Professionals, Builders and Property Owners From: Robert Morris, P.E., Senior Public Health Engineer Subject: Partial Submissions/Revisions Date: February 12, 1999 In 1998 the review of plans and the return of comments, if warranted, was constantly ahead of the time frame allotted by the New York City Department of Environmental Protection Watershed Agreement. The Department is still striving to improve the time frame involved for permit review and approvals. Some improvements are: 1) Additional personnel in the program. 2) New York City Department of Environmental Protection faxing comments /approvals (saving mailing time). 3). Reviewing the neighbor notification requirement to make the requirement less stringent. 4) Updating the filing system. However, it is also the design, professional, builders and property owners responsibility submit documents with-all pertinent information provided. A cover sheet must be attached to all documents not submitted with an initial complete application for a construction permit. The cover sheet must include the following formation for each project. A) Owners name. B) Project address, municipality and tax map number. C) Document status, i.e., revision or requested additional information. The required cover sheet with assist in reducing the review and approval time frame. An example cover sheet has been enclosed. Your compliance with this requirement is appreciated. RM:tn -4 .'-s BRUCE R FOLEY Public Health Director PROJECT STREET: NIUNICIP. DESIGN I REVISION REQUESTED ADDITIONAL INFORMATION 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 COVER SHEET OTHER (,./, /I I PUTNAhI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: q Inspected by: 72e e Street Location __� ©�c� ©o.T� i �iz�'�� Owner _ � �/-{,R'eA Town _'PA7-7-15�7z6eAj Permit # 473 Ti`1 Subdivision Lot # #-C) o'WA)Z A " 1. Seivaa „e System Area ; a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. 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. optic tank-size - 1,000 ........ ,25 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ................... .... .....................�...... �1✓ength required .�,�v Length installed oo 2. Distance to watercourse measured -71- 2v c, Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32” /foot .:........... 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 1' /2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pum .or Dosed Systems Size o pump c amber ................ ............................... 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. house In ated per approved plans ... ............................... b. Number of bedrooms ......................... ............................. —� IV. Well ' a. Well located as per approved plans . ............................... b. Distance from STS area measured 7t- 4 o 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 watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i Frnc;nn rnntrn1 nrn -tr;Aa 1 No COMMENTS 5 eTaylk �r oe IBM of f G,. BATH DRE -55�N6 L. BATH ROOM o .BDRM #I HALL 25 _8 11 T. MICHAEL DALY, P.E. BOX 243 SHENOROCK, N.Y. �G . L. MASTER BDRRM #2 BDRM #5 BDRM ` -`4 BEDROOM COLONIAL 51 NGLE FAMILY RESIDENCE SECOND FLOOR L _ D MUD R RODM Y EAT I N6 . KITCHEN STUDY G G AREA 24' FAMILY ,,L. L: ug LIVING :2 HOT'"' , FT ,, NS n !�: � ., .:.:� t ROOM BATH D I N I N6- FOYER OOM 24 FIRST FLOOR 1/811 if—on PU HAM COUNTY DEPARTMENT OF MALTS Dbdakfe d IbrvhemssW Seahh Sav 'Pi . Cm auL N.Y.111R12 anshmmilopni We PsauY t JXNSTNUCUON PST POD SEWAGE DISPOSAL SYSTEM ee C 7CATS Co y Posit N ` Twin or Y ®IISe Tam MOP 1 Ebel Ins OwMr /APPi�t Neer' `J- y � At�i>� �wol_❑ Itebke ❑ Dade of Approvd Maras Adana [ �- Toe► Y"s�.�TtC3flJ gyp- 12,/�/��/} Tl� *o Q„hA4iricinn A.nnrnvcri "'i FPp Enc1nsedf3,, Amn„nitA Sallsiling Tjpe — '�f( 3= �.��.s -' Lot Area ' � FM Sectlm Oab, LJ Dept vabumb Number d 9edrssms `'r� Design Flow G P D _J� PCSD Naldicatlou Is Eegabed Wilson FIE In oempieled S"Mrsalo Sewerage Syokm to Cartel d �'"/nE IGdble Sap, Temk �d TO be.ossabsidsd by _� '� ' Address Water Pd9k Sm* Fns Addma are �� p.h. Sqm* Wiled � Add.wr Odor Regslte�wta 1 reprewt'ahat 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate saw disposal •stem above dacrMled will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rpu ns 07 n County Deportment of Health, and that on completion thereof a "Certificate of Construction CompliancN' satisfactory to the Commissioner of Health will be "mltted, to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that said bulkier will ppc• in good Operating condition any part of saki sawage disposal system during the period of two (2) y^ Ifnmediateky following the date Of the lnu- once of the approval of the Certifk:ate of Construction Compliance of the original system or any'repe o; ) that the drilled well described ab cribed ove will be located as Shaw on the approved plan and that said well will be Installed in a the r a and rpu ns of the Putnam county Depart O ►with. -// Date O Signed P.E. R.A. Address Licence No APPROVED FOR CONSTRUCTION: This approval expires two years from the data issued unless construction t the building has been undertaken and I$ revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction "Quires a new jWmIt. Approved for disposal of domestic sanitary "wage. and /or private water supply only. PUTTFUM COUNTY DEPARTNE ' OF HEALTH DbrMs fit EtivbrtessW HaI16 SaeeI. , Cos" N.Y.1S612 b Pavlde Pfisk / err CF.YITFICATB F COIIWUANCB N PEEIIQT FOR SEWAGE DISPOSAL SYSTEM Pamir N 3 CO LfleNed at -J X 1 l�C �1� even an Village SebdlvMse Name 0 i i-tt �F- � SAd. Lot N y � Tam M" 27) wask 2- Lot T, `' ` P1 �, Emewd_ E9� Eevide n ❑ Owear /APP11100 Ne-e F'\ Date of Prevlbbs Approved t 01 ] G 1!45- { S Malling Address Date Subdivision Approved Z Fee Enclosed ❑ Amniint Balftg TyPO 5 r' 'IA _ Lot Ares I + L /-► L pIE Seetlon 0 Depth vabrme Noises of Hedrwns ,> r Design Flow G P D PC® NodBcsd a Is Regobed Wilson FM Is coogdebd SepseaM Spwarage Syd m to coo" d Ie r � .Gwioe S"a Took •mod - 5571 I— a I i= TI Z `% &W" Te be oseaae�te "by + AAA — Water SepP�: Pdbss SepPb Feaa Addrea err: Seppl► Di11Bed by �� % , , • 4 lisess OIMr Ratldeoaeets 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system($); 1) that the wpa►ate saw disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standard$, rules a rpu ns o nam County Department of Health. and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Halthwill be County to the Deportment, and a written guarantee will be furnished the owner, his sucassore, heirs or assigns by the bulkier, that saki buckler will pasce in good operating condition any pert of said sewing• disposal system during the period of two (2) yews Imnwdlet•ly following thedate of the issue amp of the approval of the ,Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above wMl be located s shown on the approved plan and that said well will be Installed in accords with din s, rules and rpu 7113ns of the P men County OWNS of Ith, Data ;7- 1� Signed ! P.E._ R.A. _ Address �L� / ,9 G linens• No—L/ APPROVED FOR CONSTRUCTION: This approval expires two ear from the date issued unless c nstruction of the building .Ms been undertaken and is revocable for 2 N may be amended or modified when cons) sa►y b e Coo missioner of Health. Any change or alteration of construction requires a n+ • . Approved for disposal of domestic ag e , or private water supply only. Rev. t 10/88 Data By Title n� PUTNAM COUNTY DEPARTMENT OF HEALTH V DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of. �, /`/%,yG9L Cl/ S� Located at y/p�,p jG.e,e.9�E (T) �7�o.t,/ Se-eti:e Block .Z Lot g S Subdivision of iA" Subdv. Lot # C1 Filed Map '# Date Gentlemen: This letter is to authorize �6.Si✓ ✓os�•°� �� 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 promulaga.ted 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 y� Countersigned: i Owner f Pro erty P.E. , R.A. , ,-7 Address rev .-h e-4- % / 25-3% A ddTress Town ZUZ /0 1 Z/_ - 773 Tel phone Telephone VJ�` 90 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 Dear Mr. Daly: 7'�% BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 40 (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." "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." 1) Engineer's Authorization has not bee signed by the property owner. r'��t e✓' v (` 12) 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 any construction. ✓4) Plan has not been signed and sealed by the design engineer. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, prop '�!? ®�i✓ e�p^ n l?-f� � X1.5 U/e.11 5 / Row Robert i�4o Morris, P. E. Public Health Engineer RM/mh watershed LOT. A0 rU1m -1 CDUMl'Y DEPAItl OU OF IIEAUIU SECU 1 ON 2. DIVIS1.00 UC I2•IVI.I2f7I`t•fFMAL IIE11L111 SERVICES DrSIGII UATA SIU. Cr- SUBSUFTCC SC1a11GE DISPOSAL SYSID4 FILE IJJ. Omier PETER 0.' HARA Address P : 0. BOX 282, PAT TERSON I NY Ix)cated at (Street) ROUTE 311 /CROSS ROAD Sec. 10 block 2 Lot 11 (indicate nearest cross street) municipality PATTERSON Watershed - CROTON SOIL PEROOL11 M BEST DnTh n9gumm 1n BE SUBnrimm W111I 11PPLICI ELONS Date of- Pre - Soaking 10/14/88 Date of Percolation Test 10/14/88 UOLC flu-am CLACK TD_m PEROO MON ratammiON Run Elapse Vepth to Water Fran Plater Level No. Time Ground Surface In Indies Soil Rate Start -Stop Min. Start Stop Drop In lfin /In Drop Inches Inches Inches 1 1 12:12 -12:23 11 24 27 3 3.66 4.66 4 12'51 -1:05 '14 24 2 12:23 -12:35 12 24 27 3 4 3 12:36 =12:50 14 24 27 3 4.66 4 12'51 -1:05 '14 24 27 3 4.66 5 O I `� t � � • PO��A t 2) 13:15-3:45 30 24 26.25 2.25 13.33 2 3:46 -4:16 - 30 24 26 2 15 3 4:17 -4:47 30 24 26 2 15 4 .S on O I `� t � � • PO��A t `pP 1 r !!:.r.. 'iii LAI - +1�I �:r�: i,(� •i ..J C 3 0 3 Z9 H,��? cep '. 04F%4 6A t� Is 1MMS: 1. Test_n to be repeats * at ranr- depth until apprexlmately ogLu-d toil rates are ubt.ainod .at each percolation test tale. Allid:it.a to' L,,-- suhnittOd for review. 2. DepUi treasuronents to be mazer_ iron top of hale. rev. 1/05 3 � � O'HARA SUBDIVISIM 'ItS'1' 111'l' 'U11TA IU)JULM-1) 'IX) BE GUI141:1'1'1:1) 141111 11l'PLI(Wriotl DLSC:RLLnaw OF ISOU S 1NODUtdl'LI W IN TMr HOLES _ SECTION 2 1011,111 I IULC 1.10. 4 0 A (1.l.. 6" TOPSOIL 12" 1R" BROWN 24" 30" SANDY 36" 42" LOAM 48" 54" 60" 66" 72" 78" 1) 4" I IOLC NU. 4 0 B TOPS IL � r BROWN SANDY CLAY ' Wete 0 80 in. I 10111 11J. 40C TOPSOIL BROWN CLAYEY LOAM ] 11DICA12 LEVEL AT VWC]I GMUNM~IT•A IS El I XIV'E M None 11101CAIE LEVEL To stuai WATER LEVEL RISES AFTER BEING OUNTE t[D N/A VEEP HOLE 013SE[Z M1009 HADE BYt J.F. EBERLE ME: 9/6/88 6 12/7/8 DESIGN Soil Rate Used 15 Min/1" Drop: S.D. Usable Area Provided 6 Ilo. of Bedrooms 4 Septic Tank Capacity g Absorption Area Provided By 500 L.F. x 24" width trends , OUter IL 4 Matsu BALDWIN & CORNELIUS, P.C. Signatur e; '•� • . Arklress RD 5 Route 22 SCAL 1960 s W • Brews ter, . New York 10509 r•,, �v o, .ses�' �a '1111S SPACE FOR USE by I1CAU11I DCPArdl -1 it Mus Soil irate Approved sq.ft,/gal. Checked by Dale 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 treet Addres To Village City Tax Grid Number 782 -., WELL OWNER Name Mailing Addre . 43.Private O Public SE OF WELL - primary 2- secondary M- ASIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM b INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED _ /EST. OF DAILY USAGE(aQ a 13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GI ADDITIONAL SUPPLY Kkdw 5UPLY N DWELLING ) O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE mfLLED DRIVEN aDUG OGRAVEL aOTHER IS WELL SITE SUBJECT TO FLOODING? YES 6,-'NO - -- 0 ! IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: J Lot No. WATER WELL CONTRACTOR: Name 16,1) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET 6C, © (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;- (30) days of'the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a.Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 P 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, ' P UT NAM COUNT Y D E PART M E N T O� H EA L TH APPLICATION FOR APPROVAL OF PLANS..FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 1 A. 2. 4. Name of Project: lilt - 3. Location(�VV /C: Project Engineer: 5. Address: M-)O K Z �� License Number: 468 Phone: -' - -05-04 4, 6. Igoe of Project: Private /Residential Food Service: Commercial , Apartments Institutional' Mobile Home:Park Office Building Realty Subdivision Other (specify)? T. Is this project subject to State Environmental.. Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency , 11. Is this project in an area under the control of local planning, zoning; or other officials, ordinances? ......... ............................... p 12. If ,so, have plans been submitted.to such authorities? .................. '� 0 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge.'? '� > Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 1 16. Waters index number (surface) ........... ............................... 1 IT. 1 18. Is project located near a public water supply system? .................. If yes, name of water supply — Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... b 1:0. Name of sewage system Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 14. Project design flow (gallons per day) .......... (0 .................... .2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?..r�� 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion 'of this project located within a designated Town or State ,1 . wetland ?...... .... .................... ............................... N U 28. Wetland ID Number ..... ............................... . ............ ... 29. Is Wetland-Permit required? ............... ............................... Has application been made to Town or Local DEC Office? ..............,�.... r 30. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving app! i cation of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity?'....... YES or NO �b 32. Is project located within 1,000 feet of existence of abanddhed:dlandfill.; hazardous waste site, salt stockpile, landfill, sludge disposal site or.. any other potential known source of contamination? .:...:.....,��.YES or " NO NO ti DESCRIBE: r. 33. Is there a local master plan or file with the Town or Village ?........:.:.. 34. Are community water, sewer facilities planned to be developed within 15, years ? -,, 35. Are any sewage disposal areas in excess of 15% slope? ....................... '.�;: �1 Map ....... ..... .............................t. 36 Tax Ma ID Number - 37. Approved Plans are to be returned to: ................ Applicants `Engineer t 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 Author.i`zation. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant,_ o Section 210.45 of the Penal Law. .., SIGNATURES & OFFICIAL TITLES: �'J MAILING ADDRESS: ..,...,...-.. rc�._••.•• <e*rn•,..�„�.- Z....,r- s+rWi>: -f.eYr 9 -rsR-v,. a ,,wsunt-- sn?c+x -�r.- ;,e'... x•.x� : iT„;.'¢;,".T+ <xy.- ..�-..: -.a,* F T`' r1 PUTNAM COUNTY DBPA01MENP OF HEALTH r ( OMMMdildrawwwwasdagenbea.' Cu" N.Y.IN12 O• w CSICIII+[CATS OF COMPI M= ,. 4. „ PRIM FOR =WAGE- DEPOSAL, srsTSM ,LJ 1 LaealMd °m or. ]VIe w. y s�ba.hra. x.'e i.l r q- g> 13 O..gdAp Nee New — Dale of Prevlou Appaovtl ill �Lj . MdbgAMOM Date Subdivision Approved tTzq— Fee Enclosed] Amni,nt sdMbg '4Pe lot Area. v Pm Sectloa Dray 1 Vabtme Number d Hed. ee�e 4" Dedlpa Plo w G P D PCHD Notlsaltlm is YequNa! When PM b o iiim d y. srpaeals Sewatfaje sy a aMt�t cif i 'Z S% GaOI� sepde Tact's To be baaiiiiiiiiii:W by ^�o ��• 1 7 Aildeeer Wefar sop*. ' Pet�9e Seppb: Ft� Address an w.i:� pelBe�bYT° . �d14ae �. Olber. 1 represent that I ,am'wholly'anp completely responsible forthe design and location of the proposed system(s)1 l) that the separate swage, ditposl 4yttem above desc►i6id wilCpe'const►iscted as fhown.on the approved ainengmant there to and in accordance with the standards; rules a r u ns o n County Depertnient,'of Ifeelth, and that on completion thereof a: °Certificate of Construction Compliance" satisfactory to the,Commissioner of Mealthwill , be submitted to the 0epertmartt and i written quarantes will be furnished the owner, his.avcpsso►; heirs or. assigns by-the. euiger thetsakl builder will pool in good Operating condition any !pert of said swage disposal "sin Aurino the period of two (2) yews lately following the'dete Of tM feu - .. em or any repeMs.t eto; )'t t the drilled we0.destylbed above tlf„ wIN be boated shgw on the app►iowd pon an4othat tsaid wall will be installed n, a�l r, wit M sate ds, N 0 to aliions PutM111, ' County Dope of Ith. .. f Date +„ I �L�'- 5 „ P E ���R A. — •Address - V • Litens No APPROVED FOR CONSTRUCTION: This approval expires two ys!sis from.tM dalii: leveed .unless construction of ta buiminq has been undertaken and is "vocable for 'cause or may 04 amended or r"Iiied when coniidered nee: y .the Co nor of Month. Any charge or alteration of conitru0tbn r ,quires a now per it., Approved foi dispopl of omestic t;aeitai aewaga, a (o ate.,wate poly only. Rev. _._.._ Date o . By Title- 10/88 li.. Y DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Stree Address X o Village City Tax Grid Number SL - -, WELL OWNER Name '.> Mailing Address -Z ,� , O.Pfivate O Public USE OF WELL 1 primary - secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ ABANDONED 7 0 FARM 0 TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT_ gpm /# ❑ REPLACE EXISTING SUPPLY [ANEW SUPP N DW ING PEOPLE SERVED /EST. ❑ TEST /OBSERVATION ❑ DEEPEN EXISTING WELL OF DAILY USAGE' Sal 12-ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE [ DRILLED 13DRIVEN DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SK TCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET i D l (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2, of Part 5 of the New York State Sanitary Code, and provided that within 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 cont .nat.e surface or groundwater. C' Date of Issue: -�` /� 19 i�;, �--- ,- -' Date of Expiration 19 l�`,e Permit Issuing Official -.11 Permit is Non - Transferrable 3/89 White copy: HD File Pinx copy: under Yellow copy: Bldg. Insp. Orange copy: Well Driller WATER WELL CONTRACTOR: Name -c i Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L--RO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SK TCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET i D l (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2, of Part 5 of the New York State Sanitary Code, and provided that within 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 cont .nat.e surface or groundwater. C' Date of Issue: -�` /� 19 i�;, �--- ,- -' Date of Expiration 19 l�`,e Permit Issuing Official -.11 Permit is Non - Transferrable 3/89 White copy: HD File Pinx copy: under Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date I i Re: Property of Located at Cox Vlp I M, ( T ) �A- iT��.X' �..� Se e t 2: ER:k 13 Bl o c It l' Lo t . I Subdivision of Subdv. Lot ## ;Filed Map # 74>0 Date Z T. MICHAEL DALY,• P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOROrK� N Y 10487 a duly licensed professional engineer or r t (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with.the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary.paper.s on my behalf in connection with this matter and to supervise the construction ok•said system or systems in conformity with th'e, provisions of Article 145'or 147, Education Law, the Public Health -Law6, and the Putnam County Sani- tary Code. /I- I Very truly yours, wf /� ned vJ Countersign ` Owner of Prop ty P.E. , R.A. , ## Address,; T. MICHAEL DALY, P.E. Address Town P. O. BOX 243 � '•• SHENOROCK, N. Y. 10587 % Telephone 62 Telephone C