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HomeMy WebLinkAbout0373DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -86 BOX 5 . Ism L IN 46i M , 00182 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ,P— 6Z - 93 12- a Located at �a f Town or Village &Li�„G --s Owner /Applicant Name - 5�-z, Tax Map Block _Lot Formerly e) Subdivision Name 0 /W4 Subd. Lot #/ Mailing Address Ad zip C 0 Date Construction Permit Issued by PCHD ML Separate Sewerage System built by ilfy, : i S VSi S Address I �-� >v Consisting of 12-12 Gallon Septic Tank and Z— 1it,•r: 'r e � •�. Other Requirements: 'e, C) 'q L, Water Su ®Div: Public Supply From. or. i Private Supply Drilled by IV Address y, Building Type �r�;y:�;�..�. Has erosion control been completed? Number of Bedrooms / Has garbage grinder been installed ?t� Address 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 Putnam County Department of Health. / Date: 014 c, l-f Certified by r- � (D pqh Professional) .�. Address -4- oz," 42.-- - License # 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 bject to modification or change when, in the judgment of the Public Health Director, such revocation,' o ificati change is necessary. By: Title: � Date: /211 /d J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 '+ 1 } T 1 T T F �� p pp e',e��/ u A Tu C® r ) IPIUTII AM COUN 9 i A H8AL 0 fi : DEPT J 1 Geneva Road ` (845) 278 61$0. .• `� Brewster; NY 10509 *� � :. - Date b , , Received 61: . o ' c, °- r 4 17i . THANK YOU i ash,- ❑`Check ® <0 ❑ Credit Card By 7TR=l '+ 1 } PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Streq Address: e P�levj � Ra&d: Town/Village: I1�r1�a Tax Grid # Map Block -2, Lot(s) ' i1 Well Owner: Address: O o tLo fboi�oAl N 6f03 Use of Well: -prima 2- secondary X Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion _X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length /plA ft. Length below grade lo! O ft. Diameter _in. Weight per foot -j7—lb/ft. Materials: A Steel —,Plastic _ Other Joints: _ Welded X Threaded Other Seal: ;_ Cement grout _ Bentonite Other Drive shoe: Yes No _ Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours — Yield 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 0 q N ,L- C° 4, 109 /710 3 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type G Capacity7 Depth ! © Model -01 Voltage a HP A4 Tank Typ Ey' Volume Date Well Completed � Putnam County Certification No. Date of Report Well rille (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prov'ded on a separate sheet/plan. Well Driller's me t �2 S� �' o'�S Address: oivL V; 0 Signature: Date: Q White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES GUARANTEE OF SUBSU"ACE SEWAGE TREATMENT" SYSTEM Ai&a Jr4W02S___ Owner or Purc er of Building Building Constrdtcted;by cvovb i �_ecio' Location - Street C13 Tax Map Block Lot TownA illage Subdivision Name Building 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 abov"escribed 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 willM or negligent act ofthe 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 1 Z Day Year General eontractor (Owner) - Signature a,_m, n ze--'s- Corporation Name (if corporation) Address: Stale! Zip Signature: Title: ( H.- 6-3, 37_ -.31 Corporation Name (if corporation) gti S 3 Form GS-97 BRUCE R FOLEY Public Health Director �Pt`1 CpG .... LORETTA 'MOLINARI- RN., M.S.N. Associate Public Health Director F �+ 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 NvIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278.6648 Imo' WaSS&V 1 ;_ 0WNERS NAME: TAX MAP ATiTMBER: E911 ADDRESS: TOWN: _. _ . AUTHORIZED TOWN OFFICIAL: G (Signature) DATE: - - 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 VERFRIvi) Aso W It Ave p 111400: Q; KAI T T, -31 ooy z . . . . . . 7 All, XTRAQUIT, fill bt Anz n - --------- 7i? I YMI... ENV IROMMENTALZERVICES 321 Kew arley Yorktown Mqiohts, N4Y. (914).PKWOO. g1pert H.. PadoVanj, liVahtme Vol W- ut -T—Pad-ovan i M. T. ELAPO 100a j, l"A00aS4 QJENT Ov 114 NON STAT PROG 0 illq E., "ITIN TAKEW 0802/01 MOW *5 OAPLE AVE! PATIHIME REWD: US123/01 1OW209 ANWAYNKTORLISH REPORT bATE4 ' 09/A4101 191l)-273-S44S- gl TE f RIDGEVIEW 106 . ... .. tqy RI 1,:. 9 R VA 104 TQRLISH, QUYSIDE HOA SIB #TE PYOCYPYRE far'godiumire proschbad. Suggestl&gAdellnes HAS, S or py6ple &-a'sodium -restricted diat,the wale, ahoqld,- Kvnp mby;Ahap RO.mg/L & Soddum. FqK, thoQ ph j; hatab rdstricted diet, a mlxjmum of 270,mp/L of Sodium suggestedc, SCALE INVITE& RANOYS-FRON 1-141 MEQUREMENT OF pQ IS ONE OF 'I F ORTAN't AN6 PREMU ENT LV USED TESTS lN WATER CHEMESTRY. :AR W 1TH pH Mll GHT BE CORROSIVE WrETPLPIPES ANO nj nEs, - THQ. - NIGIRMJ�L, RANGE OF R p" I TO EA. T, QHARDWEvS,xS DEFINEV AS TOE SUM -OF THE,YALCIUMA MAPN,SIUM YYNTRATJOIIJ� $OTH EAPRESSED AS CALCXUM*CAKSONATE,4N MaK. Av QWESS -MAP"T RANGE, FRUM 0 -TO HUNORPOS `OF -110K, DEPENDS ON QlAND TREPTMENT-TO WHICH,THE WATER +MPEEN SUDIECTED. f,WATER: 0-76 M132 Vl-..-R�`- WATER: ABOVE.S06-MG/L jqATELY HARD WATIRV700%001? Aj A I -Ll.' Vol W- ut -T—Pad-ovan i M. T. ELAPO 100a j, Y]"IL UYVIVONMEWTAL SERVICES -301 -War SkYwat Y&Ww&Heights, KY. 10598 (9 Q& 245-ES3 Alhant H. Padovani, 01resto! Aba,10%84 .............. NF r,j0LIFqRM CL; ENT ,#; i14 ---------- ----- NOW STAT PROC --- ---------- ---------- PABE S/2310. LEAD VMS) <1 DATEXIME TAKEN Oavewl 00LOO1 jyA5 MAPLE AVE. DATEITIMEBEC"N 0S/ .'S/01 10120A 10 N 1 - D W WYNi= Tj RL I S- H REPORT DAT& 0014/01 NX23101 WNQ PHONEK (91WE73-144J.F, 4.601TEINVOSEVIEW RO. TYPE; PU TAO L; -on NY SOVIUM (NjY 0.021 MB/L i D Z TORL. ism 1 TEMPERATURE..f"04C; 11 UNITS t3 Own WanowspJOTAL wo M01. 1 bi 14A JOP12,101 ALKALINYTY WS 106,01L. ryi'tS ii.T i` -40RMIA FSt swtv�r ". 'Isr,,:. € WON,:, TURaIDITY'"TUR <1 NTU� j3.. t 14 , r U RN{ ENT& JTNAWNTY PROFILE WS/23M NF r,j0LIFqRM ASSENT • 100 tf1y _ ii, 'S NT 8 S/2310. LEAD VMS) <1 ppb, %15,ppb 9101 1 W3/0& NITRATEWITROS <00 Ml /P _?j a_ QW, AITPIT9VITROM <0.01 H&L NX23101 WNQ 111(ii'L �%111/01 mAN1,3AN"E:13,1E (Hn <00100SIL 2Td/1 VDBIRS/01 SOVIUM (NjY 0.021 MB/L N •A 10/2310U PH, 11 UNITS t3 Own WanowspJOTAL wo M01. 1 bi 14A JOP12,101 ALKALINYTY WS 106,01L. RU VCd/Q1 Ell. TURaIDITY'"TUR <1 NTU� j3.. t 14 , r U RN{ ENT& irony, QE R'SWASANACATE THA , T THE WATEEP TWAS). NOT) 1::' A• YTI gar ACTORY SANITARY QUALITY ACCORDING' in 7TtHE.NEW YORK STAT-;*.'*_' 40 ErA FEDERAL DRINKINS WATER'STANDARB9, FOR THE PARAMETEss, QW, AT THE TIME OF COLL EET].ONI. V - . 1gj0 limits for p :eR Lead & Copper Wh VOK of their �kan 15,ppb and a Watmint must be ublic schools are set at A Rule for Pubiic Syptems requires that no marc--! distribution points have a LEAD value of more COPPER value of 1.3 mgjL, elfs,Wster undertaken to reduce the waters corrosive (Ijil-,ipth '.'irop and manganq, I e are present, mbined shalL not exceed Gly mg/L. their total valwe M� 7 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 (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 Date: jam. /i,2 /oca Foxwoo� ��tZfllg�E From: Gene D. Reed Putnam County Department of Health ZFor your in formation For your review As discussed Fax #: No. Pages (Including cover. sheet) Please respond Attached as requested Please call Notes/Messages "3 &-I1' � 5/ L� OF 1 ma, In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: • Inspected by: G; peen Street Location fox l✓a�n TErzTZAG Owner o `NA�,sr Town Permit # �;2 — 9:3 TM # r3 —:2—ea Subdivision Lot #. Y/ "o ;y,4 Z4 1. Sewage Systein Area . a. STS area located as per approved plans ........................ b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size 1,000 .... �.1, 250 .. ...... other ...........:.... b. Septic tank installed level ... ......... ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. 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 . Length required q O e> Length installed D� . -Distance to watercourse measured -t ­ 1o6 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 - l %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ................................... :.................... g. PumR or Dosed Systems 1. Size ot pump chamber ................ ............................... 2. Overflow tank .......::.................... ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade. .. ............... 5. First box baffled .......................... ........................::..... .. 6. Cycle witnessed by H' b.estimated flow /cycle........... III. House/Building a.�Louse ocated per approved plans.. : ...:....................:...... b. Number of bedrooms .............. /..xc'.*�'M ...dt 2. IV. Well 3, 4140 f Bonus Roo; a. Vell located as per approved plans.f " !s ,""- b. Distance from'STS area measured -- iye) ft ........... a 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. Erosion control provided ................. ............................... 12/08/2000 17:04 9142340344 LANE ENGINEERING PAGE 01 DEC- 6 -00 Tou 6'46 PM PUXAY CTY ENV HEALTH FAX H0. 19142787921 PU MAM COUNTY DZPARTNmmw OF HrALTH DIYMON OF ONML""AL i1i1 ULTH $ZRVLCU ATTIlr.N1'ION o ADAM C - $$Q iP_4T PAR iNAI 1NapF1„r1AN - For FiB All itlFbrmttipn must bo Sully 4u*I@ sd prior to any 'TcGnohw iospeotions.being made. , POW it onsttuction Pum OC Owwr /Applicant Nano: V Im ,11 Btodc 7— Lot _;,&-(d? Formerly: O ` A StMviaaaNun: Mdivimkm Lot 0 L system fill oomplettd? _... Date. is "M cumpkte? s Date: L aye oowtsucted u pa pdaas7 h well drilled? Datc: L wail located a par PI&W7 Ara erosion. centrol moasurea in place? I � tbr�t the ay�Omt( :}, at 8atd, at the above premises bat beao ca�icaed and I have iatpeatod and v*dW their couplenon in awmdum trbh the is¢red PCHD Constrocdon Pcnr;t tad approved plant and the Standards, Rules and RgpW ioot of the Putum Couuty Departma d of HUML f Datc: 4 - Caeed by: PE RA ` mfeszio Address: Al Y 105-3 Form FIRM P. 2 2. PUTNAM COUNTY F j °; Dld" •t R.Riksammada Hedlb Seevkio. "Cfi�tol. N.Y 1161? �o FwvW I•isatt 1 w CS21IIRCA18.OF.00LIANCB FSS I FOD SEWA= MROSAL SYSI®1[ Yrle�lt Az Sepae�ei Stn►araS�, S� /�;CMdrt a[ GaBa� soplle Took To be ounshaded, % `, � Adilnoai WaAW sap*. sd4l� Fsa� Ad�eai r � - n.f..a. Ste► D'e�ed by ZZ "APPe". Z i reprNant'tnat I am wholly agu compNtely responsible for the Wtgn aiW location of .the p►opos d cyst m(s) 1► pert YM er aiat• i.we •: dis offal s lit•m above- dptriissrd will be'construct•das shown on, tnp aDpro40d amerigm•nt than to arW in accor0ainee wlth'tM standards, rules an r•yu a, ores o • nor County Dip rtnw�t';of bf•eltli, .and that on compMtkrr► tna•of a,'•Ce►tifieate. of Construction _Cornpiianca utisfagtory to the Comrnimbonw of M•aKhwill a subrnRteil;'to, the "•Opa►t�in•nf and. s writtin; gwrant e, will M furnished the ownai, hit.wcassois, 6W ouassigns bY'.tha_build•r. that said bulkier will ple" in .1ootl ops•atin/ anftlitbn trey' part Hof :laid sawkie disposal syRam duiirq,,the pe od of two (21 -Years ifnnt djately following thedat• of the isw- anq of tM';atOpraralof tMCiiti( kaf •, +of,Construetbo,Corepliane• ot,tnp,o►yinafystNn ora yrepeMstM► eto: 2 ) -that the tli11N0weILANpiOaA,abow 1IrfN b• beit d f shci r, 66i ` ew0 planing. that slid well will bo Instal in accordance wi 66 etanda ,rule .and f•yu aW .;oi . the Putnam County D•Pa rherlt of: Ith: . Date Signed P.E. R.A. Addr•saL� 7 � �" t_icons• No c'. APPROVED. FOR ; CO NSTRUCTION: Thisapprovitexpi,.two, rs r m, 6. dat* i mess construction of. a buitdintl. has b•en'undertak•n and is revocable- for N qi: " ay pi, arnerml d-or modified when consider •s :y. py the rhiiiion•r of Health. Any chargs or alteration of construction re0uir•s a `. yr Approved for disposa It of Aomcstk unit e, .grid /' ' p` a' wat•.r `wpply' only," Rev. LO/SB " (/• By Title .t i DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 18, 1998 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSTS: Macaluso Foxwood Terrace, Lot #41 (T) Patterson, TM# 13 -2 -86 Dear Mr. Daly: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. 1) The minimum of two feet of fill is required over the entire SSTS area. 2) Fill is to be shown extending 10 feet past the edge of the trench and then sloping 3:1 to grade. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve ruly yours, Robert Morris, P.E. RM :tn Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSDS: Macaluso Foxwood Terrace, Lot #41 (T) Patterson, TM# 13 -2 -86 Dear Mr. Daly: May 8, 1998 BRUCE R. FOLEY Public Health Director Review of plans and. other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1 1) Trench detail is not correct. Minimum distance from the bottom of a trench to ledge is 5 feet and to water is 4 feet. Revise accordingly. 2) Current codes requires that fill is placed is the expansion area. 3) Proposed contours are to be shown. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, Robert Morris, P. E. Public Health Engineer RMKtn PUTNAM COUNTY DEPARTMENT OF HEALTH 'V DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ZZ2 Re: Property of Located at ?C (/SIOQ!� %�,QQ� (T) ��?Sa✓ ate.. l3 Block Z. Lot 06. i Subdivision of Sub dv. Lot # Filed Map # Date Gentlemen: This letter is to authorize SEi9�✓ 3-o"'aN ` )iw y a duly licensed professional engineer L-�or `_- (Indicate to apply for a Construction Permit for a separate sewage system, to serve the.above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly :Z..."0000000\ Signed Owner o roperty Countersigned:'^ P.E. , R.A. , # 63J Address Address Town Z ;! Telephones e Telephone '7�) ,e ,4`i r--,57- K O E5FP'-IF ,�ov�1J tq 0 C01,1 t`A C-- N 1` L � T��=2 Jr� .T HI F2j oM T; ,F V1 ocl s (V &(oT !!51 ake-D -3 ?,6-:.-rJ TZ 6)'11,41M , CS) 'Tt 0 X�2w PAL O'HARA SUBDIVISION '1'M'r PIT UNrA IU)JU.11111 '1'0 133 SU11•I11 '1'l� W1'lil 11l'1'L1C11'1'1.U11 SECTION.2 L)mc JPnou or 5-011S EiJCXWNI'W W IN TL:ST MULES I)UP111 110LC 10. 41 A 6" BROW 12" 18" ' -SANDY 24" 30" LOAM 36" ...421@ W /TRACE OF CLAY 4800 54" 60" 66" 72" 78" 134" I.1IUI0ATU I1Wm AT Waal IIOLC 1J0. 41 B BROWN IIULI: 11J, 41C BROW LOAMY LOAM SAND ROCK 0 5 ft. BROWN LOAMY .CLAY is- None 11 H)ICAIE LL• VCG To JIMCU Ii1TFR LEVEE, RISES AF EM BEING Et X l>cTiEitID N/A VMT HOLE ODSMMTIONS t•IADE Bit J. F. E BE R L E DATE: 9/6/88 UE.SIGN . Soil Irate Used 7 (2*.) Min/1" Drops s.D. Usable Area Provided 5 � 'U 110.. of Dedroa� 4 Septic Tank Capacity 17��, g. OF N gals. Absorption Area Provided By 400 L.F. x 24" width trends ! P r Other 2' ft. fill require d ,6461•it tua 0 ie ` � ,.•OAP i ''•'• A' .1V 11mou BALDWIN Si9na`e & CORNELIUS, P.C. U c. h3dress R 5. Route 22 SEAL s • At L� w • Biewster= New York 10509 •1111s SPACE Wit USE BY 11CAIAII DEPAtt'u•IEt1P C ALYs Doll Irate Approved s9q.ft/gal. CUecked by Date - LOT 41 ' . PU1t-UU7 OCURIY DEPI1Ir12 EM Or lli11f,1U SECT ION 2 DIVISION Ur EMIltUtt• WrAL REAU111 SUM E5 DESIGN DATA SIIFrr- SUBSUE -ACE Sr3vME DISEMNL SYSTEM FILL Dj. Owner PETER 0_'t1ARA 10dress P.O. 80X 282, PATTERSON, NY Located at (Street) R Sec. _.14.._ Block 2 Lot 11 (indicate nearest cross street) MIHICipality PATTERSON Watershed - CROTON SOIL PEttMUMCH =T DhTA RDQUI R ED TO BE SUI3M117ED imn RPFLSGITIONS Lute of 'Pre-Soaking 9/15/88 Date of Percolation Test 9/15/88 HOW h1U•OM CI= TIME PEROOLATION FUML11TION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In 1-Lin /In Drop Indies Inches Inches 1� 1 10:45 -10:48 3 24 27 3 1 2 10:48 -10:51 3 24 27 3 1 3 10:52 -10:55 3 24 27 3 1 4 5 2) 1 3:30 -3:35 5 24 27 3 1.33 2 3:35 -3:40 5 24 27 3 1.33 3 3:45 -3:51 6 24 27 3 2 4 3:52 -3:58 6 24 27 3 2 5 2 rA IUL S: 1. Tests to be repeated• at came depth until approx mately cgtlal coil r ues are obtained .nt oath percolation test hale. M. data to. hr- :,ulanittw for review. 2. Depth neasurctimts to be oracle iron tcl) of 1»e- rev. 9/05 I I I DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #� WELL LOCATION Street Address K (se-WO/Village/City O t1 Tax Grid Number ­8-c WELL OWNER Name M 1n Address rivate OPublic USE OF WELL 0- primary 2 - secondary ®-IMIDENTIAL O BUSINESS O INDUSTRIAL OPUBLIC SUPPLY ❑AIR /COND /HEAT PUMP OABANDONED O FARM O TEST /OBSERVATION O OTHER (specify []INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 5— gpm /# PEOPLE SERVED _& /EST. OF DAILY USAGE (.W gal REASON FOR DRILLING El REPLACE EXISTING SUPPLY O TEST /OBSERVATION ANEW SUPPLY EW DWELLING ) O DEEPEN EXISTING WELL 12. ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE E DRILLED DRIVEN ODUG 11 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES � NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 0 KAY` 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 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 thirt3, (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�� -inate surface or groundw Date of Issue: G %`j% 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 �7` T �-!!T`� 'M !T N -,- Mk E "'1" 7-7f," 7 7,77.77, UNr \ 7 YAM 7 C8E1H+[G18 OF 00 t11D'IIANCB a CO PZEW FM* JW*Aft!DiF0W ftUICk., # im got 1 ?7 • D*, Date' ubdiVision.A _ Fee .:Enclosed Tn `7 above 4ii6ili", *Ill, In constructed is' shown , 'o-n- 6--1 apprord amendment then t 0 4 .r­ , 1 11 1 idinciwith. '' ttiostindiial, i0i - niacco saftyagglations,of, the, ruins be. I'll. ails outhitilsiooei of ificate of Cohseruction Conipliance,or -the and that sm id, well Will beinital County Departmoft Of h Date APPROVED FOR CONSTRUCTION m for, pure , if mW6 rai a nave I ! :of 6 oms*ic son ary sewage' Rev. 10/88 Do M,bulmer will of (2)�-YIWG late 4i a he �r any I agems t* the - is d led Wth gig r Ns ...iSIM1611 3nsof the tnam P.E. Iii. es construction of the)building has been undertaken and Is dinner I 0 , I 1 I'M as , . Ith. Any change .. o . r alteration of construction I Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 4 lam"' 6Z_gl WELL LOCATION _-- Strejet Address own Village City Tax Grid Number WELL OWNER Name Mailing Addres Mftivate O Public E OF WELL primary 2- secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify U INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY M-fEW SIEPLY XNgjj DWELLING p PEOPLE SERVED_ A /EST. O TEST/ OBSERVATION. O DEEPEN EXISTING WELL OF DAILY USAGE_(j&D gal Q ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN DDUG O GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS•LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. �. WATER WELL CONTRACTOR: Name 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: n LOCATION SKETCH b SOURCES OF'CONTAMINATION PROVIDED '0 ( `D N PARATE SHEET I c (date) (signatu 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 SanitarylCode, and provided that within thirti- (30) days of the completion of water well construction, the applicant shall: 1. Pump.the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County-Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a m nner as not to degrade or otherwise conta rface 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 I . ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of E- AIZ A Located atj( �. MA (T)� -cam( �„� Block 'k Lot ' Subdivision of , s Subdv. Lot # ,qJ� Filed Map # 2 '7-74.,) C) e) Date_ T. MICHAEL DALY, P.E. ' Gentlemen.* CONSULTING ENGINEER �Y P. 0. BOX 243 This letter is to authorize SHF.NnRnCK N X ioSS7 a duly licensed professional engineer' or ((Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all 'necessar -y papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity Vith the provisions of Article 145'or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. i• Very truly yours,. n e d Countersign / Owner o Property P.E., R.A., ## `Z Address T. MICHAEL DALY, P.E. t 0 �'� : �� •��, 12 -5� Address Town P. 0. BOX 243 SHENOROCK, N. Y. 10587 Telephone ' Telephone i J, r%. -i f PUT NAM C O U N T Y D E PARTMENT O F H EALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 0��Q� 1" & 4, M, 4 : 1 Z i(v 5 2. Name of Project: iii - 3. `LocationJVV /C: � 4. Project Engineer: 5. Address: License Number: 48 4-68 Phone: 6. Type of Project: ;i _yC 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? ............. I��A 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; • ` orother officials, ordi.nances? ......................................... 12. If so, have plans been submitted to such authorities? ^� b 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge.'�:�P Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?...... ... _ 16. Waters index number (surface) ........................................... 17. Is project locatedinear a public water supply.system? .................. ., 8. If yes, name of water supply — Distance to water.supply 9. Is project site near a public sewage collection or disposal system ?..... _ '0. Name of sewage system Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) .......... F'5.(o .................... 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.._b______ 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland?.. .................................................. 28. Wetland ID Number ........................ .. .............................. 29. Is Wetland Permit required? a Has application been made to Town or Local DEC Office? 30. Does project require a DEC Stream Disturbance Permit? .................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, b landfilling, sludge application or industrial activity? YES or NO s, 32. Is project located within 1,000 feet of existence of abandorlpd:Iandf'i11 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 Village? :.. — ' b 34. Are community water, sewer facilities planned to 6p developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ......................... 36. Tax Map ID Number ............................... ........... �. 37. Approved Plans are to b pp a returned to: ..............:, Applicant `Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to'comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant,. o Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 0 T. MICHAEL 'DALY, P.E. BOX 243 SHENOROCK, 91. 4 BEDROOM COLONIAL 51 NGLE FAMILY RESIDENCE } L D MUD R ROOM Y G G FAMI-LY-- ROOM .rte HOUSr ._ 24' BDRM #1 BDRM #2 0 EATING, AREA I•�_[1L`i'fi C L. G BATH ORB551 N& L. BATH o ROOM /1 GL. GL. HALL BDRM #3 _II' SECOND FLOOR KITCHEN 1/8" = I'-0" STUDY FOYER G j GL. FIRST FLOOR 1/8" = 11-011 MASTER BORM LIVING ROOM 25' -511