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HomeMy WebLinkAbout0374DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -87 BOX 5 00183 MIL ON 1 .i,4L 9 IL 6 'L is L :�' L I 4 1� r 00183 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMMPLETION REPORT Well Location Street Address: cx; t"f`f<C,e Town/Village: /�� ;�h Tax Grid # Map 1'6, Block 2 Lot(s) 81 Well Owner: Name: Address: Po 9a AU f MAO; Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm . Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion -A Compressed air percussion Other (specify) Well Type Screened Open end casing Y Open hole in bedrock _ Other Casing Details Total length __.gLft. Length below grade ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded __4/ Threaded ' Other Seal: _ Cement grout _ Bentonite Other Drive shoe: _V 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 d If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type'ju8M SECapacity Depth 14 0' Model J0 C4d7 Voltage I-W) HP ) /'�- Tank Type '161xil01­- Volume t'v2 Date Well Completed �Alw Putnam County Certification No. 007 Date of port s Well Driller (signature) NOT : E ct location of well with distances to at least two permag6nt lan arks to be provided on a separate eet/plan. Well Driller's Name Signature: �, r Address: 3// Gds! Date: 5 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 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM D,E .Wi G4H,5 pwc; 10H Owner or Purchaser of Building Go N 5 T N cola! -{ Tax Map Block Lot Pfl (°15fL6o)4 Building Constructed by TownNillage I R4 yn mly 'R5 ��6 Location - Street 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 me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day 'Year Signature:�✓�� g ✓L✓� -. Title: 11�5TP��'11- General Contra < r (Qlv r) - Signature V -t5 m. C, oHib I- k401 -\ Corporation Name (if corporation) Address: State Zip 9•6 -�j % Corporation Name (if corporation) Address: $o &Zy- L�1,0 f�� State W Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights,, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.908381 CLIENT #: 3692 NON STAT PROC PAGE 2 DEW_CONST. INC. DATE/TIME TAKEN: 12/23/99 03:00P PO BOX 420 DATE/TIME REC'D: 12/24/99 10:00A PATTERSON, NY 12531 REPORT DATE: 01/19/00 PHONE: (914)-878-2015 SAMPLING SITE: 11 FOX WOOD TR. : PATTERSON, NY, 12563 COL,D BY: ERNEST FINNEY NOTES...: KIT TAP ---------------------�� DATE FLAG PROCEDURE is suggested. SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 RANGE OF pH IS 6.5 TO 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 () TO HUNDREDS OF MG/[, 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^ [`|~" -- -= - . . « ELAP# 10323, YML ENVIRONMENTAL SERVICES 321 Kear Street ' Yorktown HeIghts, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.905476 CLIENT Q. 3692 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DEW CONST. INC. DATE/TIME TAKEN: 01/20/00 01:40' PO BOX 420 DATE/TIME REC'D: 01/20/00 02:00P PATTERSON, NY 12531 REPORT DATE: 02/03/00 PHONE: (914)-878-2015 SAMPLING* SITE: 11 FOXWOODS TR. SAMPLE TYPE..: POTABLE : PATTERSON, NY, 12563 PRESERVATIVES: NONE COL'D BY: WILLIAM FINNEY TEMPERATURE..: NOTES...: KIT TAP COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 01/20/00 IRON (Fe) 0,084 MG/L 0-0.3 mg/l 2037 COMMENTS: ` Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED B L� �'��]Alber`t 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 #: 32.908460 CLIENT #: 3692 NON STAT PROC PAGE 1 DEW CONST. INC. DATE/TIME TAKEN: 12/29/99 01:30P PO BOX 420 DATE/TIME REC'D: 12/29/99 02:30P PATTERSON, NY 12531 REPORT DATE: 12/30/99 PHONE: (914)-878-2015 SAMPLINGSITE: 11 FOXWOODS TR. SAMPLE TYPE..: POTABLE - '' - : PATTERSON, NY, 12563 PRESERVATIVES: NONE - COL`D BY: DANIEL FINNEY TEMPERATURE..: < 4C NOTES—: KIT TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 12/29/99 MF T. COLIFORM ASSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT r WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: �J'jrt H. tadovani, M.T.(ASCP) Director � ���.`^ `^-�` ` ^ ` / ELAP# 10323 v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # �- Located at 11 FOX VI®0D 71'1594LA GE Town or Village FATFaMo H Owner /Applicant Name D'E'S' CpH5iR+1LTiol -1 Tax Map Block Lot Formerly Subdivision Name Subd. Lot # 41. Mailing Address F'O' o1C, quo PRTT6L SPH' H ``i Zip Date Construction Permit Issued by PCHD Separate Sewerage S sy tem built by N!'V4- 00H5TP -' .T VA Address POR +U QMUL&H H- 1` L3 Consisting of ,WQ Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From 4590 Lr— PS6 ; � H" Address or: Private Supply Drilled by I%-i' A � krr Address 1 r a KV Building Type 1 Q1i ly Has erosion control been completed? 5 Number of Bedrooms Has garbage grinder been installed? NQ 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:. "�1 " ®� Certified by Address 94 1 W T ty-V POO (E P.E. YL R.A. Professional) : P-- H-1- License # % aA- 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 , dificat' or change is necessary. By: Title: �J /�ii Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ZNSTQUCTED IN AUZRD- N FARO RULES AND E PUTN.�M COUNTY DE- TH AND 7HE NEW YORK T dF HEALTH. $ c, - _ , .yak' ,, -� t 'i t ....1r rh 4' f ' < b : =`,� ,`� �y' �P .fin,. io " -F `" ''_,r.,�15 •' rY' •x' `s { ' t J 4 r i` 'F''°r' ^Y^ �3, -3`C.' AYT.0 } '�.ss dGy. x�'T" Y 'L: r� !14� XeA, .^S. i. �y.�'' ' mtt'o v �'+, Y-� 4.' -L". ba'S -2 in GL''> •-' - r &Y y� b •'� F -�s �t i fi :, t K t , o § x = T ... �' �s {' d .t. f c` Y i',, c--, 4 r K'f � y xir^:i afi .- h`h r t ^t# r •r � .• :. r`' ,�55 }� ,� i u: ti x 0 '�,S y �" ¢ x" � 4r"rrr a_d x� �e a'�i �• �^� �'+ y'ii4 f w 4" k; s r a ,° ; c _ —� 1. 5 "C 'x i 5., -3 C ti. x-'• = Y k'n k yt rYy G ° �i .` It, S 5` 4 1 +�'>- Y„ ^' k �,' '. .l M1 y'} . t '� fY. Wig. 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J• � v 1 mrr T"t+� n, C� ,y pi+ .2,'„" , I , .- " s '� h �.:� }� , f t L i � a E ., , .2 r L z Htsc °u t c ;,f ,r 6 :�'r�O- - ��" r ' :'? s t r $ ` ; -~ - 1 7 3 5 z � . .�- r ' . p 1 7 -r �� - !;,A� • .r'� �x ^= � r a -` "gym • . w-a .�, �` '0 4 `-e . 711 j zn � s <N ;f t 1x.4 f l y ' 8 ��, � �� -- - s � � "-' "- ' �ci f ..'a � :d y'! �. ;.. y y ,,t..f• 1-1 1. j Y *i ; m* r l t ,,tea A . �r ' *'� t 2 5 3 Y_ i t .� 1� 9G' �,`� •,- Ti�.1. k `ti,-'i 4 L• "s S ��. 4 V`.- `q d_ p :T .y! #4 v t s'.z""SV' •; s d'r "k'3° R"*Qa° '�'ar�. `�`Y Sys'?`' :,,' '�' 3 rr b 1-1 u., '',�'z r Ss.rT � w r _ is..�w '.:� I "S� v� � o �.a,^s 's y \,- - F. � '` ',, c. - V n• .11 .� 3' �2E/ _ Y 11 - _ r. .e. F January 31, 2000 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual °SSDS Compliance O'Hara Subdivision - Lot #42 Foxwood Terrace Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -42, "As -Built Plan," dated 1- 31 -00. 2. Certificate of Construction Compliance for Sewage Disposal System," dated 1- 31 -00. 3. "Guarantee of Subsurface Sewage Disposal System," dated 1- 31 -00. 4. Well Completion Report, dated 8- 20 -99. 5. Laboratory Report, dated 1- 19 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nicho Jr., P.E. HWN:JM: his 99054 / LAURENT ENGINEERING ASSOCIATES, P.C. 20 Milltown Road \ Brewster, New York 10509 \ (914 )278 -6108 : (Fax )278 2658 Harry W. Nichols Jr., P.E. CONSULTING SUE ENGINEERS January 31, 2000 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual °SSDS Compliance O'Hara Subdivision - Lot #42 Foxwood Terrace Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -42, "As -Built Plan," dated 1- 31 -00. 2. Certificate of Construction Compliance for Sewage Disposal System," dated 1- 31 -00. 3. "Guarantee of Subsurface Sewage Disposal System," dated 1- 31 -00. 4. Well Completion Report, dated 8- 20 -99. 5. Laboratory Report, dated 1- 19 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nicho Jr., P.E. HWN:JM: his 99054 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 1059G (914} 245-2800 Albert H. Padovani, Director LAB ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ #: 32.908381 CLIENT #: 3692 NON STAT PR 0 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PAGE 1 DEW CONST. INC. DATE/TIME TAKEN: 12/23/99 03:00P PO BOX 420 DATE/TIME REC'D: 12/24/99 10:00A PATTERSON, NY 12531 REPORT DATE: 01/19/00 �-15 ppb 9101 PHONE: (914)-878-2015 NITRATE NITROG SAMPLING SITE: 11 FOX WOOD TR. : PATTERSON, NY: 12563 COL'D BY: ERNEST FINNEY NOTES...: KIT TAP �---------����������������� DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 12/24/99 MF T. COLIFORM PRESNT /100 ML ABSENT 1008 2 /�Q � LE HU (���/ l.D ppb �-15 ppb 9101 12/24/99 NITRATE NITROG <0.2 MG /L 0 - 1O 9139 12/24/99 NITRITE NITROG <0.01 i3- /I N/A 9146 12/24/99 � IRON (Fe) 0.349 MG/L 0-0.3 mg/l 2037 12/24/99 MANGANESE (Mn) 0.024 MG /L 0-0.3 am 1/1 2037 12/24/99 SODIUM (Na) 3.89 MG/L `/A 12/24/99 pH 7.4 UNITS 6.5-8.5 9043 12/a4/99 HARDNESS�TOTAL 122 MG/L N/A 12/24/99 ALKALINITY (AS 92.0 MG/L N/A 12/24/99 TURBIDITY (TUR 1.5 NTU 0-5 NTU 12/24/99 E. COLI (CONFI ABSENT I( /ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS> S NOT Y F A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NE y STATE AND EPA FEDERAL DRINKING WATER STANDARDS, 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% points have their distribution point 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 red4ce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for SOC11LUM are proscribed. Suggested guidelines state that for people on �d sodium restricted diet,the water should \ conta-1' h o more than 20 mg/L of Sodium. For those on a ` moderately restricted diet, a maximum of 270 mg/L of Sodium � � � \ . . > PUTNAM COUNTY DEPARTMENT OF HEALTH Re - iH gp' DIVISION OF ENVIRONMENTAL HEALTH SERVICES 2// 510e, FINAL SITE INSPECTION Date: 8 Inspected y: �•, �ee� Street Location ©x \,�lbo°p 1 L�iZ7�4G E Owner ,�1I77A Town ' PAn° Z7 e Permit # ;D— � 3 -- y TM # / 3 8- 9 7 Subdivision Lot # 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. 1 00' 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. AT. outlets tlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ...... .............................Q)0�p f. rent 'es" 1. Len -h required —72 Length installed 5Z; 2. Distance to watercourse measured 49- o 0 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' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. PUMD or Dosed Systems 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.D.estimated flow /cycle........... `tea ousel 'ocat idj era ` roved laris � `tea -Nell located as per approved plans ..........................Q V'� Distance from STS area measured •-t- loo ft........... let" Casing 18" above grade ........................... ld Surface drainage around well acceptable ....................... V. Overall Workmanshin 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 & dinto exist watercour! STSarea ...........0K­ ....................... .............................. Y L+ J 1N V U V 1V11V1L'' IN Is C161. x K X X X_ X e -a Q v corm 3 1 -J t',; 08 -16 -1999 02 :34PM FROM TO �7! 6 PUTNAM COUNTY DEPARTIN ITT OF HEALTH DIVISION OF EN WRONXIENTAL HEALTH SERVICES GIN 92787921 P.01 PCHD Construeti n Permit R Located OX WdOO 7W tfiog k'/j /tom Owner /A Jicant N eatmS �CVYAA-oo" pP Block, Lot? Formerl Subdivision NatYt�/�iQ Is system fill completed)_ f Date 17 -��' �9 Is system complete? Dat __,K.._ %b 9f_ Is system constructed as per plans. Is well drilled? � , : Date 4- - 99 For: Fill Trenches ff rr�j Is well located as per plans ?�,( Are erosion control measures in place? 1 certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance the issued PCHD Construction Permit and approved plans and the Standards, Rules an :gFikl�i the Putnam County Department of Health. y�P �,� . H eNo� , Date: �f ~��" G%� Certified pio rte►; /t 7riWA/ OW fkEtv1 nv #V, /U S`o 0 Comments: V/ 5-6 Form FIR -99 TOTAL P.01 rVIT4w COURff DSlAi l OF REALTH h DNYMsIta[I�elrebpo It,".Seedema C51sed: N Y 11612 to Pwvlde ieanh w CEQ1D?1CATS OF CO1t1pIIANCB MINIX ]FOR ► Dom, SYS= 1.alMi as wooP 7�e,5 4e& ar Vow ` oZ Tta Map —-- .D 7 . L .� Ras Date of ' v Mdft A&WO nP ubdivis ion. ARRroved 2-- Fee Enclosed 0 DlfYia� 1YM— f'C` 'I. _Lot Arai` 1 L • FS Seetioo 0ob D�ptb ydme Nobs et Beltttli:e Dodp Flow G 'P D 4 YegW�ed Wbett V o mPletell S OC3 PC® N6tlfintlou F111 Sepeepta U,,iW Sirbn to furW et �Ga➢-o�si Sflptic Took . Addro,a . . Water Sopp¢: /plc Soper Fto� —. Address &w* DrOd by / /�. 7 Aaa..m OIMe Raq�sOeRb .., 1 represent that 1 -am wholly and completely responsible for ten despn and location • of .the proposed system(s); t) that the separats sniu di nI s stem above desc+ibed well M constiucttad as shown on;tne approved amendment their to and in accordance with the standards, rules a regu ns o nam . County Department df "ItN and thafon completion there ofe'!C,"ficsto of_Construction Corh ,'cal satisfactory to the Commissioner of Mealthwill be submitted to tM;.Oepntl,s and a written 'guarantee will 0e:. furnished thr•owner,_hi}wccessat, holrs,or anigns.by the builder, that slid builder will piece, in 'good opsratirg eon0ition any pail of'•saia sawage disposal system Burl the period of two (2) Ywn immediately following thedate Of the lfw- ana of the apparal of ten 6kOicite of Construction Comptii'nto of'tne orginal tysteni a any repaMS tM►elo; 2 tent the drilled well described above well ".located as shgwn tM`approved plan and that said well will be stalled m accordanw w ten :�St "i�6 a nd requ n . Of ten tam County Osipart of ItA Date Sghed V. E. _ R.A. — y: 'AdWetis�"°'�1_ pG � License N6 22! � APPROVEO Mi. CONSTRUCTIONt This appii al axp�y rs orri he ,date 'issued unless constrq On of the building .has been "undergken and b revocable fora or may, i4'arn rwed or m6gifiea whin consider ry b Comrnlssioner of 1'iealth. Any change or alteration of construction reouires a ilelw i Apfiroved for disponl of dom"Ic M a ape Ovate water supply only. Rev. 3 l��- 10/88 Dee er Title DEPARTMENT OF HEALTH Division of Environmental Health Service. 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278-7921 November 3. 1997 Sean Daly Box 243 Shenorock New York 10587 Dear. lklr. Daly: I�/-e�. BRUCE R. FOLEY Acting Public Health Director Re: Proposed SSDS: O'Hara Lot 42 (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 signeLby th e property owner ✓2) Trench cover is to be noted as geoteYtile. ✓3) Erosion control measures are to be shown and detailed for the house well and SSDS. Furthermore, a note is to be added stating all erosion control measures are to be installed prior to the start of anv construction. .I4) 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, hav 9040 Robert -Morris, P. E. Public Health Engineer RR L,,'mh watershed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 2 Re: Property of t71 USo Located at �X KI,9027 l, rT��a✓ o , �✓ (T ) , � g� - 13 Block Z Lot 87 Subdivision of ��i, /9 Subdv. Lot # / Filed Map # Date Gentlemen: This letter is to authorize S"' 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 yours, Signed Countersigned: 04iier,, roperty P.E. , R.A. , # �3 � /) � �r'�Z - -T AJd�dr e s s Address Town /JUD 7 5777a) Teleph ne Telephone 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 OF-1-5.71—Is WELL LOCATION St e 2Address To Village City Tax Grid Number WELL OWNER Name Mailin Address d3-private O Public UfE OF WELL primary - secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY D ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT d5,— gpm /# E3 UPLACE EXISTING SUPPLY ErREW S PLY (NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE4vol gal ❑ TEST /OBSERVATION M ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DefILLED DRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 4 "NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: _?A Lot No. WATER WELL CONTRACTOR: Name _1�> :7 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 .& OURCES OF CONTAMINATION PROVIDED SEPARATE SHEET 7 2,, , �e:,, � (date) (signatu PERMIT TO CONSTRUCT A WATER WELL This permit to construct I 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 mann r as not to degrade or pate surface or groundwater. '-� � - Date of Issue: 19 l�� Date of Expiration 19 S Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller w 14Z ruji i i OD MI Y DCPARZIMEM OF HEALTH SECTION 2, DIVISIM OF LNVZtZOI -IUMAL I1EM1II SEUVICES DESIGN UhTA SUMr- SUBSUFAC-E SDIAGE DISFCiSAL SYSM4 FILE t1J. Owner PETER O'HARA Address P.O. 80X 282, PATTERSON, NY Located at (Street) ROUTE 31 1 /CROSS ROAD Sec. a_Q Block 2 Wt-11 . (indicate nearest cross street) iudcipaiity PATTERSON Watershed - CROTON SOM PERML)1TICti TEST DATA ItDQ== TO BE St)i1 UTIE) mil APPLIC1YIUMS Date of 'Pre-soaking 10/6/88 Date of Percolation Test 10/6/88 HOW PF.itUQUU.LVW PIIKDLATICH Ho. Time Ground Surface In Indies , soil Rate Start -Shop Mtn. Start Stop Drop In Rin /ln prop Indies Inches Indies 1) 1 3 :28 -3:58 30 24 25.5 1.5 20 2 3:58 -4:28 30 24 25.5 1.5 20 3 4:28 -4:58 30 24 25.5 1.5 20 A, 2) 1 3:25 -3:55 30 24 26.25. 2.25 13.33 2 3:55 -4:25. 30 24 26.15 2.15 14 •3 4:25 -4:55 30 24 26.15 2.15 14 I WES 1 1. Tents to be repeated* al• came depth until npprcvcdmstely equal coil rates are obtained at eadl pc..reolation test Dole. All data to' tr_ subntttbd for review. 2. Ueplh measurernnts to Ix! made fran top of (role. rev. 9/05 s I 3 j • O'1IARA SUBDIVISION 11'1',.`'r 1'1'1' I)1_Y17► jwJ U.110) 10 BC SU13141'1-ria) 111'111 111'1'LL( Nrl.011 SECTION 2 DL•'SOUly ION OF GOILS E P0U11NtQ= IN •'1ST IIULES UI:1'111 HOW 1.10. 42A HOW 110. -42B HOW 1». 6 12" Brown II3" SANDY 24" 30" LOAM 36" 42" 48" 54" 60" 66" LOAMY Brown LOAM BROWN LOAMY CLAY 72" CLAY 78" 134" I1I0ICATE imam AT Wu1a1,GR0UHDWrdER IS ER000NTER D None m ID mr. LL•"VCI, TD Wuca INTER LEVEL itlsEs AFT'lrlt BEING ENmUNZ mm N/A VEEP 1101.E 00SI3 MTIONS MADE BY: J. F. E B E R L E DATE: 9/6/88 11a"va BALDWIN & CORNELIUS, P.C. Signatu» ? Z o0 DESIGN Soil Date Used '20 HW1" Drop: 8.0. Usable Area Prwid �. a • arewgter. New York 10509 r�P,, •`���` • 1b. of Dedrocre 4 Septic Tank t;apacity g M • � tt Absorption Area provided Dy 57_ 1 L.F. x� 24" width trends 'r Wier Alt. desian or dosina reauired ..'e��. '� ��`nl•',. � Soil Mte Approved sq. fVgal. Checked by bake Wax 11a"va BALDWIN & CORNELIUS, P.C. Signatu» h3dress RD 5. Route 22 SCAL i°0 , ,1980 • -'�,� 4Ew r' a • arewgter. New York 10509 r�P,, •`���` • 31118 SPACC FUR USE DY !t[?1 mll DCPAIt' lair cmys "•• "' " Soil Mte Approved sq. fVgal. Checked by bake \ \�O Irul [ a)DNtY DEPARTMENT OF HEALTH `Q DbbiR d Rievbume aw soft Sravleve. Ctatalel, N.Y. 14612 to pnob Pemlt r w CBR1>PiGTS OF CONNIJANCE x PEEIHZ FOE SEWAGE DISPOSAL SYSTEM " Legated at Town ar V111066 Subdlvmn Na . Lt r T. Map Hbeb , 'tee 11 Aaoewal_ 19� �❑ Date d Prevbee Approval �0i 7� [ P z- !<allirS Ad&vw _ Tow. - Date Subdivision Approve d !?i_ Fee Enclosed ❑ Amnnnt I L�i� i l /�L� Lot Area Fm Sectlee s.YS Type ooh Depth Vohtme Nvbae d Dedtee�e `' Dodge Flow G P D � PCHD�Nodilmdon b i oquhed When FM b completed Sepali o Se"aw Spa. a to m" of G" Septic Table ma 7 J LJ r -Pro' o' T• ba,aeeebraa/ed b2 Ti Adihm water Stippbs 11 up Supply Bees Ad&eea an SW* DdSed by �T +'i�;� Agarese Other It.�bbv.e.a 1 rtprtsant;.that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate Mn l s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu s .1 na County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantes will be furnished the owner, his sucamors, heirs a a 's by the builder, that seal builder will pled in pod opa►atkg condition any part of said sewage disposal system during the period of two (2) years Nttly following thedate of the Imu- once of the approval of the Certificate of Construction Compliance of the 01191 or an repairs t o 2) t the drilled well described above wgI be elated es shown on the approved plan and that said well will be Installed in wi he sta u nd regull ns of the Putnam County Department o Hes Date C� 11�q! Sian P.E. v RA._ Address X etnse N _ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the betiding .Ass been, undertaken and is revocable for gust or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction rtouiress a�n�ow p "iit�.y Approved for disposal of domadic sanitary sewage, aid era a ytater only. 1088 Data G/ �,�� o... /�•": � Cc"-"_. -_ _!� TitN :- I a Ls� s� PUTNA [ CODxTT DEPAnIUM OF HEALTH Dh idue d Ebvb•m cooed Hedlb Saev1, Cw" N.Y.10W Effs0aeer to P.wla. Pda�it r a CERIMFICATZ OF Co .}r Tat Map Ebel rat �L O..edAppra..tx... �\ f�lt+r�et. Renewal-0 Rovblen ❑ j Dated Approval MuSh,B Athbee � k �� `fr ^ r , f Town !�r, _ 11101"s Type � ' Lot Ara �•� Fm seaabn Only Depth VaWw Ntaa bar d Hedtwe�e Dedp Flow G P D PCHD Nollentlo o b Rociahed When Fm b completed Selawalle Suwewp Span to oebabt d 9D fie9w Sepik Twk -Z- 1 To be ougalke ed by �� ` + 7 AdThoa Water Supply., Pablle Supply Front Addmea en Supply DAW by_T ;;3 ' Adamse Other Relslbbaaalba 1 rtprtsMt .that 1 am wholly and completely raponWrle for the design anti location of the proposed system(Q; 1) that the separate di sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu saw ns o na County Department of Health, and that on eompNtbn thereof a "Certificate of Construction Compliance" Satisfactory to the Commissioner of H•althwill be submitted to the Department, and a written guarantee will be fumished the owner, his sucasaors, MMs an by the bulkier, that said builder will OIaCt in good operating condition any ft of said sewage disposal system during the period of two (2► s lately following thedat• of the l au- enp of the approval of the CertNkatt of Construction Compliance of the original system or ny �tp. ) that the tlNll ed well described above wilt be bated as shown o the approved plan and that Saki well will be Installed in ce th t es and rpu ilIgns of the Putnam County Depart of Ith. Date] Signed P.E._ RA. _ Address r""WX C License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has bean undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any charge or alteration of construction requires a new per it- Approved for disposal of domestic sanitary tawrage, a rivets water supply only. n Rev. J 10/88 oaet sue— 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 # I & aAA WELL LOCATION IS WELL SITE SUBJECT TO FLOODING? YES [ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name - ��P�.� 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 N SEPARATE SHEET (date) ignature 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 thirt3r (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: / XZ 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 _,,:,Street Address o Village City Tax Grid Number i- WELL OWNER Name rp Mailing Address :. k ®.Private O Public V.E OF WELL - primary 2- secondary G�IDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT - gpm /# 13 REPLACE EXISTING UPPLY DNtW SUPPLY (MEW ELLING PEOPLE SERVED /EST. OF DAILY USAGE(oj2!j Sal 0 TEST /OBSERVATION 12 ADDITIONAL SUPPLY 0 DEEPEN EXISTING WELL ,REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE QUILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES [ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name - ��P�.� 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 N SEPARATE SHEET (date) ignature 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 thirt3r (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: / XZ 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date g Z Re: Property of Located a tXc�47IS iA (T) ��Titi( Se $lock] p Lot Subdivision of Q Lt/sop.' t Subdv. Lot # �Z Filed` Map # Date Ile T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER , s This letter is to authorize P. 0. BOX 243 SHMORo , N Y 111587 a duly licensed professional engineer or regist�rP�.�r ^h'+ ^t (Indicate to apply fora Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam. County 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 o.f Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, ned �'' C�. CountersignesL- — l' Owner df Pr.operty P.E. , R.A. Addr.Oss T. MICHAEL DALY, P.E. CONSEFEMG Address Town P. 0. BOX 243 SHENOROCK, N. Y. 10587 7 2 _ C Telephone aid Telephone PUT NAM COUNTY DEPARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS �FOR A WASTEWATER DISPOSAL SYSTEM orn 1. Name and Address of Applicant: �•�• "dux � ` � 2. Name of Project: 3. Locationj�V /C: 4. Project Engineer: 6*4 5. Address: 1�0K 1- y' License Number: �� Gi'� Phone`:.° ZU'—O 6. Tyee of Project: Private /Residential Food 'Service Commerciol , Apartments Institutional Mobile Home:Park, Office Building Realty Subdivision. Other (specify) a,. 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted S. Is a Draft Environmental Impact Statement (DEIS) required? ............. �IA� 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? ........... • ............................. "F�►- 'cJr��T" 12. If so, have plans been submitted to such authorities? .................. nl � 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge:' `'. >'-�x)�, Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... " J. Is project located near 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 1 1. Date observed: Distance to sewage system 23. Name of Health Inspector: 4. Project design flow (gallons per day) .......... � 0 .....:.............. 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? .......:..... .... .. ' .... ... ....... ... 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 invdlving appli.ration of pesticides to orchards or other crops, solid or hazardous- waste d Aposal, landfilling, sludge application or industrial activity? ........ YES or NO b 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village ?,:.:........ 34. Are community water, sewer facilities planned to be developed-within 15 years ?+;.�b 35. Are any sewage disposal areas in excess of 15% slope? ........................ 36. Tax Map ID Number ..... ........... ................. 37. Approved Plans are to be returned to: Applicant 'Engineer If the application is signed by a person other than the applicant. shown in Item 1, the application must be accompanied by a Letter of Authorization; Failure to comply with this provision may be grounds for.the rejection of any submission. I hereby affirm, under penalty of perjury, that informal on provided on th)s form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant:. o -Sect ion 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: T. MICHAEL DALY, P.E. BOX 243 SMOROCK, N.Y. 4 BEDROOM COLONIAL' SIN&LE FAMILY RESIDENCE L �\,j MUD Ptoom y ) Aim IIFAMILY -24 BA BATH D�551 N6 L. BATH C) ROOM BORM #1 GL. CL. CL. HALL 25 MASTER BDRM #2 BORM #5 BDR-M SECOND FLOOR EAT IN& KITCHEN STUDY AREA LIVING :2 ROOM DININC-7 FOYER -ROOM GL. rC.L. ]I FIRST FLOOR 1/811 = 11-00 As) VF