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HomeMy WebLinkAbout0375DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -88 BOX 5 y , ro J.■ ■I !� 16 h■ % 1 WJJ�6 1I I ti 1Z\\0 PUTNAM COUNTY DEPARTMENT OF HEALTH, b Ptwvld� Fa,�lt Dhmm d anbo,se,W Heft Sasvkm Causal. N.Y. 14612 TE OF COMPLIANCE PERMIT FOR SEWAGE DISPOSAL SYSTEM c.�_ Lot r 0,,,,dApp3,W Ni... n Z' .. a CERiII+ICA. �,P,slt r %4—q3 Two Q V=qp T,w ?*W i B10d Lot Dde of Peevloao, App,.,d NZ, 22o 1 °2 Fee Enclosed ❑ Amntrnt � TyPe ICS i T�"]_f�. ► 1 tA(_ Lot Arm Fm Seedw Only D� vohtoe Nlsnab•r d Bedeetida ` = DWW Flow G P D ^ PCHD NoUdtsdoo b Requind�Wiseed P10 Is owtpleted Sepoeale Seweter S"im to on" d o, S,pdc Teak T• be aslaucted T—', ° 9 Address Water Sup*. Pltblk Supply From Adbm ,�t a/ � s•vpb Dt1Ded by "T' '�'`i� �tw�e.. Otb•r Rnntlu4e.e,b 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate so, va1Le diva gstem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules anoresu ns o County Department of MORI% and that'on completion. thereof a I•Certificste of Construction Compliance" satisfactory to the Commissioner of HMlthwill be submitted to the Department, and a written guarantee will be furnished the owner, his sucoeaers, MMS assgns by the builder, that aid builder will place is good operating condition any art of aid savage disposal system during the period Of two (2) Immodlately following the date Of the Hsu- ance Of the approval of the Certificate of Construction Compliance of the original sy em or any !W; 2) that the drilled well Wsvlb•d allow veal be berated as shdwn on the approved plan and that old well will be Installed nee th t ules and regu aMons of the Putnam county Depart Of Ith. Date l iDQ� Sign P.E R.A. 111 f Address �k J L� Licence No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction the building sus been undertaken and is revocable for cause or may be amended or modified when considered necessar ��om issi n r of Health. Any change or. alteration of construction ZeV • "Quires a new Wm t. Approved for di sal of domestic w, a l�w��vv��� r-wPPlY-onlri" — G/ Title LO/88 Date e A\i LIX'PRIMIT PUITU [ COUNTY DEPASTN Nr OF EZUTH Dh "d Bavb,os,eW HeaNb Servl,ea. (,UMOL N.Y. 14511 b Pisin Pau* r •, C8R'I�iCATE OF COMPUANCE SEWAGE DISPOSAL SYSTEM Ov„r/Ap,rc.,t lea.. -'7( Two er VO"e Ter: Map /3 sea 7_ im Re,ewd_0--- Rodd•a Dab of Ptovlon Aprp,�oval /�� %y! �y Tower ✓1r��'s c�✓N z %% 53 woo Fnr1 ncarl ❑ A-- „,,,- noofta TIPO Lot Ares ' / I F11I Sectlo, 004 I LJ Depth valotae t Nivb,r d Heiuwa Dodo Flow G P D PCHD NotlBntl•, Is Regabed Wbea FM Is o,aplsled Sepaeab Simuse a Sydes to c•„bt of GaO„ S•pdc Test i�� Z —� T• be , -by 7131 At &caw m Water S,spplyt P Bo Supply Frous —Address; Supply Ddhd by }° % �� Adder r Otbar Rer1u4,se,t, 1 represent that 1 •m wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew • dis oal system above described will b• constructed as shown on the approved amendment there to and in accordance with the standards, rules an reou a suns o • na County Department of HMRh, and that on completion thereof a "Certificate of Construction Compliance” satisfactory to the Commissioner of Heelthwill be s amltted to the Department, end a writ s ten guarantee will be furnished the owner, his successors, heirs or assigns by the build, that said builder will place in good opwatWq condition any part of said sawage disposal system during the period of two (2) years immediately following thedete of the Issu- ance of the approval of the Certificate of Construction Compliance of the original system of any repairs thereto; ) that the drilled well described sells be located • dtawa d the approved plan and that aid well will tee Installed in accordance h the stn rds, Ns and regulations of the m County Depart of Rh. Date Slaned P.E.— R.A. — Address v License No .7 3 J APPROVED FOR CONSTRUCTION: This approval expires two yeFAs / m the date issued unless constructln of the building .has been undertaken and is revocable for to or may be W amended Or modified when Consid , n pry by the miaflOMr Of Health. Any change or alteration Of construction "Quires a t Approved for disposal of domestic a r e, and/ water supply only. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL LA PCHD PERMIT #P'R WELL LOCATION Str et Address 00-4/Village/City Tax Grid Number WELL OWNER Name Mailing Address Qftivate D Public USE OF WELL 61 - primary 2- secondary 04(ESIDENTIAL 0 BUSINESS D INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PTU O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT _gpm /# ❑ REPLACE EXISTING SUPPLY (WEW S PLY NLV DWELLING PEOPLE SERVED /EST. OF DAILY USAGE 60� &al O TEST /OBSERVATION LIADDITIONAL SUPPLY 17 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ILLED DRIVEN DDUG [:]GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES v NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. G(-� WATER WELL CONTRACTOR: Name ^ Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C_-Ne NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET QT�- C�y �/��n (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, thirty (30) days of the completion of water well construction 1. Pump.the well until the water is clear. 2. Disinfect the well in accordance with the requirements Department attached to this permit. granted under the provisions and provided that within the applicant shall: 0 of the Putnam County Health 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 otherwis - ork�aminat sue__ rface or groundwater. Date of Issue: 19 Date of Expiration 19 /C' Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller LOT 43 • pU1t Wt QXUI Y DITA911•01r UC 11EA1,1U -SECTION 2 DIVISIOU OF ENVIIIQZ•iCN1:11L ILMIA11 SE•31VICES UIS101 U11T11 SUEEr- SUBSUFACE SMAGE DLSEVShL SYSTEM F1I,C t17. Owner PETER 0 -JjARA A&Mess P.O. BOX 282, PATTERSON, NY Locatod at (Street) ROUTE 31 1 /CROSS ROAD Sec. .10 Block 2 lot 11 (indicate nearest cross street) 1•funicipaiity PATTERSON Watershed - CROTON SOIL PERCOLATION TEST DAM IMQUMED TO BE SUDKI27ED IM11 11PPL10n'UMS Date of'Pre- Soaking 9/16/88 Date of Percolation Test 9/16/88 11012 12:45 -1:15 30 111.t•1F M CLOCK TIME PEROO TI ON rERCDLATICN Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Indies soil Rate Start-Stop Min. Start Stop Drop In 1.1in /In Drop 1:45 - 2:15 Inches Inches Indies 1) 1 12:45 -1:15 30 24 27 3 12 2 1:15 -1:45 30 24 27 3 12 3 1:45 - 2:15 30 24 27 3 12 A 5 2) 1 1:24 -1:54 30 24 27 3 10 2 1:54 -2:24. 30 24 27 3 10 3 2:24 -2:54 30 24 27 3 10 .._.. 4 5 7; I tq N 4 . `OpPOAA r� f l,; S E A L �Q n 04Sf,r� �~ 1011E'S1 1. Tests to tr- repeated tkt same depth until opproximtely cntml toll Mte9 are obLabiod at eadi percolation test: Dole. All data to* b_% suhnittbd for revie•4. 2. DepUi nea :uresomb to be m-Ae fron top of Bole. rev. 9/05 Ulna >!1l r:. l.. 6 12" 1R" 24" 30" 36" • 42" 48" 54" 60" 66" O'HARA SUBDIVISION I*EG1' 1'1'1' I)A*rA IiUJU.LIIW 'lU Ul: SU11•il.'1fW 111'111 AVVL1(XI!J.U1! _ _._ SECTION 2 ULSCILU'1'ION OF SOILS 124OWNrOUM IN TMr HOLES IOLC 1.10.. 4 3 A HOW 140. 4 3 B 11U1.L' 11J. BROWN J GRAVELLY LOAM BROWN GRAVELLY LOAM 72" 78" 0410 . WK 311UICATC LEVEL AT WHICIl GPOJNOW MM 18 II4000N'i'FIt>!D _ __ None 11 IUICAIE LEVEL TO MUCH WhTM LEVEL RISES AFM BEING iZ1J3UrTi'F21ED N/A DEEP I IDLE ODSCIIMIONS I• WE BY: J. F. E 9 E R L E DATE: 916188 DESIGN ,' Soil hate Used 14 HWjL" Drops � S.D. Usable Area Provided 6000SF 11o. of Dedroams 4 Septic Tank Capacity k298' gals. P _� s• Absorption Area Provided 13y 500. L.F. x 24" width trends' Other 1b"u , BALDWIN d CORNELIUS. P.C. fuldress _RD 5,, Route 22 . Riewater. New York 1Q509 1 USC DY ONLY: ' Soil Irate Approved ssq. f t/gal. NV- - '►� :. SEAL. 1980 • t• 1 � 4�. .............. Checked by Date Q 77 low dftidziiv�� um wiklii� 004WINAN"', B s 4111 CER!_ II�iCATS OF CO G" ST37M Peed . . . . . . . . . . ism Lot P Tait 119ap Bb a R*vMM-0 Dab of Onvints Aproval Melft Address." IF To..—+ 2 patc Subdivisldn',Ap e� 741 -97— Fee Enc"16sed, Amn.n 81110118 T'� (oj A. Fil: Seetles gab Depth Viiiiiis PhIMA d-loodissin p Deel'Now G 0 D PCHD Ned8ndw b Revehed Wbw FM Is coutpleted SOPeraft UWWMp siovit ta;balder d Sepdc Twa ano ild To lie o i IlMi' Md S�ppb Fees Addives by location of �the, proposed system(s) 1) that "the separate disposal System I m 0"..- above d@W*d 7S'how"'n on the approv"-aTendniont. there to and Ineccortiance:with the staneqjs. rules ana rQuallons or Ine Putnam County on 6inpletion to.. ther*O cakifici O.-of,61istruction C6mplWnce'! Satisfactory to the Commisgoner of HIMIthwill N , suortiltUid 16. She Pepe "t.. ".- 4. written be furni haown4i. his suc 'S. he -%1W. &iaiens ISy . the bulkler, that aid bulWW will muci condition any ort,q! - ta!iti i g svite u the S:lTrnpdiataly foillowins-th"Odate of the inu- anice of the a of the certificate of ,Construction corrigAin . nce, of - i Will I cyst or. r g"to that the drilled will deacribed a60- wilt be loc1=44i theipproved plan and that aid "I will be 14til Sad.L WI . t S a" reipulations or Ins Putnam ft of nty C"N Cou P.E. RA mt. Ad*eis—' License APPROVED FOR CONSTRUCTION: This ap��V61 expires two yaersfrom,the."te' iisued . unless const,dCilo. of the building has been undertaken and is cyni!! u (evocable for cause or may be, aiv�.434. nioil ROW when C -Wy by'Oe C6nirniatonok of Health. Any change Of alteration Of pnstr tion as a new r i. -am -vivate water soppy, Mv. r'wmit- Mt i4j"I of doo;iestic sanitary aviop 06y, only. Is 10/88'a' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL �J PCHD PERMIT # � WELL LOCATION St e t Address Village City Tax Grid Number WELL OWNER Name Meiling Address P LLErivate O Public SE OF WELL 1 primary - secondary 94SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 4�5_ gpm /# O RYPLACE EXISTING SUPPLY QtEW UPPLY NEW DWELLING ) PEOPLE SERVED /EST. OF DAILY USAGE ( gal O TEST /OBSERVATION 13 ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MAILLED DRIVEN E]DUG []GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES ---'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: E Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C_'1�0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & OURCES OF CONTAMINATION PROVIDED to N SEPARATE SHEET e (date) s 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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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� Date of Expiration 19 C . Permit Issuing Offici Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller T. MICHAEL DALY-1 P. : BOX- 243 SHENOROCK, N.Y. 4 BEDROOM COLONIAL SINGLE FAMILY RESIDENCE C BATH DRE -56I N6 L. BATH Ro0.m $DRM #1 GL. GL. CL. HALL G L, MASTER. BDRM #2 BDRM #3 :. BDRM SECOND FLOOR I/8" = I' -0" 1/811 = 11-011 ---4S' 24' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at hDK idncrD (T) �� -r �.� c_etiek Block Lot_�j�_ Subdivision of Subdv. Lot ## - 3 Filed Map #�j 0 ?j4po e>� Date ✓L ... ! s •f.° t R.. T: MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHFNnRnrK, N InK87 a duly licensed professional engineer or re,g,izter-=- h� +-��t (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam Coukity Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of.sai.1 JR 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,' � Gltic� -- ned Countersigned P.E., R.A. , ## 3 T. MICHAEL DALY, P.E. Address P. 0. BOX 243 SHENOROCK, N. Y. 10587 9/j- / Z e -- 0 _CZ)•4- Telephone Owner of Property e,. 1? �� 7> Address • Town Telephone r. ' P UT NA M COUNTY DEPARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: 4a/-JTnA 3. LocationdV/C:'��n 4. Project Engineer: ,a 6. Address: '220 JQ License Number: 4846A Pho6e,: " 6. Type of Project: r 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 (SEAR)? Type Status (Check One) Type. I.. Exempt Type II. Unlisted ✓ ` 8: Is_a Draft Environmental Impact Statement (DEIS) required? ............. f�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? ........ t-v .-c' -" 12. If so, have plans been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? Date Granted:' ^ 14. Type of Sewage Disposal System Discharge.G?.r:> 6y GF- Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?..:..... 16. Waters index number (surface) .. .... .. .............. ................ = 17. Is project located near a public water supply system?` .................. 18. 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) .......... .................... Y 25. Is State Pollutant. Discharge Elimination System ( SPDES) Permit required ?..�„� 26. Has SPDES Application been submitted to local DEC Office? ................ 27. Is any portion of this project located within a designated Town or State 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 involving application of pesticides to orchards or other crops, so lid or hazardous waste disposal, ,! landfilling, sludge application or industrial activity ? "........ YES or N0 1J 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 br,,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 ... ..... ............1,:..�' 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 4 application must be accompanied by a Letter of. Authorization.' Failure to'-comply with this provision may be grounds for the rejection of any submission;, .T hereby affirm, under pens l ty of perjury, that information, provided on this form is true to the best of my knowledge and belief. False statement. made' herein are punishable as a Class A Misdemeanor pursuont o Section 210.:45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS:3X i Re: PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Z �� Property of 6, 1"'0g6"'&U5O Located at � X 141pBZ) 7TA2AOW -6 , .✓7, OS (T) P'oq 77 ,25pill 4e� mss...... � Block Lot Subdivision of ©�f�/9.e/9 Subdv. Lot # �� Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer (.Indicate T—. 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 yo Signed Countersigned: &10-01 Own of Property P.E. , R.A. , # 633, Address Address Town 776 - 5- 77-3 Telephone 1/y 921� Telephone ©� �eL DEPARTN ENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278-7921 BRUCE R. FOLEY Acting Public Health Director Sean Daly November 3. 1997 Box 243. Shenorock, New York 10587 Re: Proposed SSDS: O'Hara Lot 43 (T) Patterson Dear :l-Ir. Daly: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "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. ✓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 any construction. ✓4) Plan has not been signed and sealed by the design engineer. Upon receipt of a submission, re,,,ised to reflect the above, this application will be considered further. RAM /mh watershed Very truly yours, fiO w /&UO Robert Morris, P. E. Public Health Engineer