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HomeMy WebLinkAbout0376DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -89 BOX 5 J F 'To �'6 00185 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF � ENVIRONMENTAL HEALTH SERVICES CERTIFICATE' OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM 0 PCHD CONSTRUCTION PERMIT "� 3b- Located a 1A 7 2a.-P, � 7, �4S01t/ Owner /Applicant Name /S t rig >X?_ o Tax Map /3 Block Z_ Lot Formerly !% Subdivision Name Subd. Lot # ft�LL� zip 0 Mailing Address O� G'/�d�'% �9 SE /jO�W p /p� 5- Date Construction Permit Issued by PCHD ` Separate Sewerage System built by fzcA,,OA;k ii3 / ' 190 Address / o.%/,/ Consisting of /2-5'n Gallon Septic Tank and Z,� > Z-/ /,,,/ Z y" IZ Other Requirements: Water Su plv: Public Supply From ,, or: Private Supply Drilled by ,s Address Address /DS-07, Building Type &9- ; 7 i+o �11Z- Has erosion control been completed? i Number of Bedrooms '`� Has garbage grinder been installed ?!� I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the s dards, rules and regulations of the Putnam Date: C. Certified by `� e Address of Health. R.A. 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 su ject to o ification or change when, in the judgment of the Public Health Director, such revocati 1 , od' cation r ange is necessary. j 1 By: Title: Date: l 6� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 'i z rPUrevann c ®uNTY - aLrH 7, 7 2 4 GenevBRoad *(914) 278 -6130 r Brewster NYx10509 Date 177= 19 Received of r 4 ra ok C The Sum Of f Dollars f�, xFO r-,. ,-,. ❑�kCash ' � ❑ heck = '�' M O ❑ Gredit Card By '� '� �-� x� f - a al I 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 9 Inspecte Street Location ®x �.Jr�� "?"�'i21Z�� Owner `lit C)'"ApA Town PA-7- r�t�s�V Permit # - 3 TM # 13 02 - 8 9 Subdivision Lot # 114L T?A�• 1. Sewage System Area a. STS area located as per approved plans .........:............... b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................. ............................... d. Stone, brush, etc., greater than 15' from STS area........ e. 100' from water course/wetlands, .................................. II. Sewage System a. Septic tank size 1,000 ....... ,250.. ...... other ............. b. Septic tank installed level .............. ............................... c. 10' minimum from foundation ........ ............................... d. Distribution Box 1. All -out- eetts at;-same elevation -water tested ............... 2. Protected below frost ............... ............................... 3. Minimum 2 ft.Original soil between box & trench( e. Junction Box - properly set .......... ............................... f. Irenches T.-E—eng-th required 7.1- Length installed 2. Distance to watercourse measured +- SOO Ft........ 3. Installed according to n ... ............................... 4. Slope accep able /1 - 1/32" /foot........... 5. 10 fr m rty lip ft.- o da 'ons.....::. 6. Dep of trench <30 inches fr f ce ............... 7. Room we or p on, 0 0 .................... 8. Size o ve - 1' /z am ter clean ................... 9. Depth o in ench 12" minimum...,-.,." .......... 10. Pipe en s capped ...................... ............................... g. Pump or Dosed Systems Size o pump chamber ............. ............................... 2. Overflow tank .......................... ............................... 3. Alarm, visual/ audio .................. ............................... 4. Pump easily accessible, manhole to grade. .............. 5. First box baffled ....................... ........... .I................... 6. Cycle witnessed by H.D.estimated flow /cycle....... III. House/Buildin a. House located per approved plans ............. :.. b. Number of bedrooms .... ............................... ... IV. Well a. Well located as per approved plans.. ...... b. Distance from STS area measured ft4 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 plat f. Curtain drain outfall protected & dinto exist watercoi g. Footing drains discharge away from STS area........... h. Surface water protection adequate .............................$ i. Erosion control provided .............. ............................... Rev. 6/97 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Foxwood Terrace Town/Village: Patterson, NY Tax Grid # Map Block Lot(s) 44 Well Owner: Name: Address: Ricardo J. & Dana Ribeiro, 60 Lafayette Street, New Rochelle, NY 10805 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 82 ft. Length below grade 81 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded Other Seal: X Cement grout Bentonite _ Other Drive shoe: X Yes: No Liner: Yes X No Screen Details Diameter (in).!, Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test; 113ailed .X -T mped ;_X Compressed Air Hours: 5 Yield.. 25 gpm Depth Data Measure from Iand surface static'(specify ti)" r ; 301ta r • z � During;yield test(ft) Depth of completed well in feet Well Log If more detailedp,t; information ,1F descriptions or sieve analyses , are available, please attach. tDe th Fro>hr"Surface, Water xBearm g... Well tD,ameter {tn) f f y `Formation ' ` ?" , i ;. Descry P �` ft '' ft` Land Surfacer v ;' 30.,E Drllin inr.over urden: cla :and .}�oulders` " 30 . Hit roc at 30' '? 30 82 Drllin in `rock set casin ` ,routed 82 210 Dri11in in rock granite ;.> r,,., If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 77 ,m Depth 120' Model 7GS05412 Voltage 230 HP 1 Tank Type W5_1 Vol u e 62 Date Well Completed 6/14/99 Putnam County Certi nation No. 002 Date of Report 8/16/99 ell ril r (i ture al, r. NOTE: ExajNe f well w' distances o at lea t two permanent landmarks to be provided on a separate sheet/plan. 4 Putnam Avenue Well Drille al So Inc. Addre ss: Brewster, NY 10509 Signature: Date: 8/16/99 Malcolm eal, Jr. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY 39 -3 MILL PLAIN Roan - DANBURY, CT 06811 (203)748 -7903 - FAX (203) 748 -0652 CT Cert: PH -0404 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAT; & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 8/5/99 TIlVIE COLLECTED: 12:00 P.M. COLLECTED BY: MTB DATE RECEIVED @ LAB: 8/5/99 TESTED BY: LAB# 11471 REPORT DATE: 8/11/99 RIBEIRO, LOT #44, FOXWOOD TERRACE, PATTERSON, N.Y. TANK WELL NONE RESULT: 0 0 ND 7.29 0.53 <0.005 <0.50 226.0 .248.0 0.037 <0.01 4.3 0.003 ml = milliliter mg/L` 1 milligrams per Liter * *Notification Level * "Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L 'no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015 * ** ND = none.detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 8/5/99 SAMPLE, AS TESTED ABOVE: DOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) E Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 � � is }� Rc .. _ Yrt ;ja✓r '� � e � H"IG4a�\ �` • `E V , f t , y F jA PR PR V � 'LO PH , 48 ICY 5 A;.; =' `l # .� , -// ffc /f _ //! —Jj! 'S1 T FEIQGE '1"YP . • / Ire Q=� o� r • -. _ -- -'- _.T- ,.,,.�._, ,,.'.� -.� v - '?••�-- n....�. _ -- .�.Z,••,a,�.— ;.,�. -t.., ;.a,...n... � -rr� -. -a ."-��T �;.: - ., -i"t'- � . °.".r"•'.��, s _ . r lOTNAM COUN1DtA i OF SALTS DhYw d SeaN Sesa C"4—NY. 16? Fii�warto pii [a0 MCEMFIGT$ , : •!� FOR U'WAOB DISlOiAL SYST®IR• " # LOS C8 T sarat NEW, Nlre Lat Tim M*P j Bioef �- im — .1— ow Renewal_ [Ql Date of prevloas Approt l EJk Town ubdivision A '' 'v Fee Enclosed ❑ ` Lot Arosi t_ r [dZ617 " Pfli Sectlm Ottgr �. Yaloltae Nm bw Of Heiewia ' ,1 Dew Flow G P D PC= Notldlatlu6b R"ah" *he, It M.otaspkbsd Stipee.es S.wae.S. Srten ti ce�.t d GaBeo Sap* Tack .sd �—E-Z 1d Te be ow�hsiebd,b�:� s Adtbeu - Watar Stappq: Fantle Sop Fto�' Addeeae an f ve.... SAO per' br -� A.ta..w Odwsr Regdeosenr ' ' 1 represent that 1'am wlroily a" :iompietaly 44 nsible for the design and location `,o( tnn, proposed systenl(s); l) that the separate aew di YI s atom above described will be constructed aa`4'01Mn on the approved amendmenfthere _to and in accordance with the standards. rules and tog u ens o nam County Debllrtnl t of Health; -'and that on completion shereo/ a ^Cartificato - of "construction Compuanca^ satisfactory to the Commissioner of Healthwill be submitted to, the Departriie�t and 'a; written aiarantaa' will bi furnished the owner; his succeaewk MMs or ns by the builder; that Yle builder will place in good operating cogdnbn.'any• Part.:o /' Yid sswvap disposal system, during the period of two (2) y " t i bly folNSwine,tMdata VIM iw- anq of: the approvaf'ot tM icertitkats of Construction Compliance of the or system or any repairs t the drilled wNi'tlae►IbeO above wx1 be looted as 4wwn.On {t�M�approwd plan anAahat. aid welt will be Instilled in accor ce h t rd a and rpu ns of the Putnam WbMY Oepamenl 1'� KJ I f7. Sign P.E. �RA. oe AAtlre*s °`7fiitr © License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date. issued unless construction tM buikfino .has been undertaken and is nvoubla for cause "or. may Oe;amentlW or modified When t OnfidMed necessary by. tha InmiGNOner of Hwnh. Any change or alteration of construction nquirea a now Plirmlt.. App►04 for tliapOYl` of tlomastk sanitary sew `, rld /Or • . ttl Ise only. Rev . 10/88 veto ,—�` Title - ' 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 PCHD PERMIT # WELL LOCATION Stre t Address HD File o Village City Aj Tax Grid Number WELL OWNER �1ame Mailing Address PPrivate O Public E OF WELL (JIT--primary 2- secondary "SIDENTIAL O BUSINESS D INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT UMP ❑ ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY O-NfW SUPP Y NEW DWELLING) PEOPLE SERVED & /EST. O TEST/ OBSERVATION O DEEPEN EXISTING WELL OF DAILY USAGE Cc�gal GI ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE C3DRILLED DRIVEN ODUG O GRAVEL O 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 "0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF �l SEPARATE (date) CONTAMINATION PROVIDED SHEET signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completionj'Report on a form provided by the Putnam County Health Departme- During all well drilling operations, the applicant shall take appropriate action to assure the any and all water or waste products from such well drilling operations be contained on this it property and in such a ma ner as not to degrade or otherwise contam1n-at-e--s face or groundwat�• 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 + MIN AM COUNTY DEPAI�TP OF HEALTH a Ptaavld• Pesit / 14 /1 Dhkhm d Enbes�entd Hedlb Serdm& Caned, N.Y. 10512 ao CERTfFdCATB OF CO CE cep N PERM FOR SEWAGE DISPOSAL SYSTEM r Town w vubge S�bivbiw N--,, . W pi� g— Taa Map Mock c3k, Lot Owaer /Apprlwnt Noe Rew@ws ❑ RevMM ❑ Affmvd Name M611-21. E� Tewa / I zh, Date ubdivision A Fee EnclosedQ� t now" Type �� `'�iOt A., �p Fm Secdm Oaf LJ Dopfb - Vdooe Namber of Hedeo ./� Deswa Fiew G P D id % (' PCHD Notlftrtlw Is Eequh ed When FM Is completed Sepana umew Sydelim, a ow" Ge &MM Septle Teak and To be,eeelfanead by 5 Adlkees Water up*. P m. Seipp+ Feoea Adhose Otber Requkemena 1 represent1hat 1 am wholly Atli completely responsible for the design and location of the proposed syst•m(s); 1) that the separate saw disposal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standard; rules a rpu of o a County Department of Toadish, and that on completion thereof a "Certificate of Construction Compliance" actory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successor$, or ssigns by the bulkier, that said bulkier will plat• in good operating condition any part of said sewage disposal system during the period of 2) year 1 mediately following thedete of the tau. ante of ten approval of the Certificate of Construction Compliance of the original em any i►f t ; 2) that the drilled well described above well be bated as shown on the approved plan and that said well will be I Mied 1 r nas It rules and regu ons of the Putnam County Depart Of Ith. Date (a '9125 Signed 11 Addn Limnss N APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless con uct n of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction ►equine a new per T. W ed t r tpofal of domestic sanitarwage,• and/ iva a water pity only. Rev. Title 10/88 Date - By , MHAM COUNTY DEPARTMENT' OF HEALTH a / DNYee d Epvit"UMEW saw* Seevbl, Card. N.Y.1d612 Pwm* f OF OO� FOR SEWAGE DISPOSAL SYSTEM Lseaad alt �4 .�1` 4` y X c4c" / 6 K /— /r— 4 swwhbien Nxm O l t4A-e_ k Saba_ Let Oweiel/AppSeaeit Naeee 1p, D ,' �� Am L, , (° 82— M, I c►TB S ` 0A1 Town Town a YShge Tax Map I3 » Z Lot Renewal_ ❑ Dane Of Psevim Approval /e) `., 1-5` TTown T/_-= 11�� <1> CJ zip 11 5Q IZ-5-D 5-72- L-�Al, Fr. CaLe /-y '2, ��. y Sepaeate SeweeaRe Syeaea a eenalat d GaUw Septle Tack ma To be •em4wefed by �� �� Ad&m Wader Selppb: Sw* Rota rte^ Addireeii as Slip* DeMed by ° —Aad m Odw 1 r p• ►•sent that 1 ame wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate saw di "'*am above described will be constructed of shown on the approved amendment there to and in accordance with the standards, rule f a regulations 0 • tlam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be County tted to the Department, and a written guarantee will be furnished the owner, his succaffor$, heirs or assigns by the bulkier, that said builder will place in good Operating condition any part of said eavray disposal system during the period of two (2) years Immediately following the "to of the is•u• atla of the apparel of the Certificate of Construction Compliance of the original systen► r any r•p•ir,Y" AI 2) that the drilled well described above well be located of shown on -the approved plan and that said well will be instal In accords ith ten rd r f nd rpu ions of the Pu m County Depart Of Ith. / /�na Date Signed �%� / l P.E. -� R.A. Address `s _ '�' License No 7 APPROVED FOR CONSTRUCTION: This approval expires two y ►s nom the data issued un efs construction of the building .Ms bee undertaken and 19 revocable for ce so o may be amended or modified when consul Wry by the missioner of Health. Any change or alteration of construction r•quiras a now per it, Approved for disposal of dorno it sewage, and /o► ate water supply only. Rev • Title 10/88 10/88 Oat• eY \N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at (T ) a77x,2S0// fez = -. 3 Block Z_ Lot _ Subdivision of Subdv. Lot # L Filed Map # Z 3 Date Gentlemen: This letter is to authorize .Svc/ ✓ot> -,, %�•�y a duly licensed professional engineer Z--�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. Countersigned: P.E. , R,.A. , # 7Y 63 S L,t2i .3oX Zy,3 Address .S 'A/ a(DS7e)7 Telephone Very truly yours, g�Lr Sig n ed ' Owner of Property Address Town Telephone �c DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Sean Daly Box 243 Shenorock, New York 10587 Dear Mr. Daly: BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 44 (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." `�.pu,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 been signed by the property owner. J2) Trench cover is to be noted as geotestile. ✓3) Erosion control measures are to be shown and detailed for the house well and SSDS. JFurthermore, a note is to be added stating all erosion control measures are to be installed prior to the start of any construction. J4) 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. RNLI/mh watershed Very y yours, ma*960W Robert Morris, P. E. Public Health Engineer 530 4" G LOT 44 ►/ /;=T. fN. 1.&a2 f 'c fi rov j: Lo *DH / r *DH t AL. ASO RY f/ 9` /i NO ►HELL NITHIN loo' fi TAN �rf f% /! // PROP. 55D!5 // 0� 0� a L1_ADER P007IN DRAIN D15GH. 0 -c` L•u' 44 FV1W1P1 . 00MY DITARMEW OF 11EAL111 -SECTION 2 DIVISICR4 OF EWIMI -IMI 1L, 11L•A 111 SEUV.ICES DMIG11 LATA S11EEr- SUBSUETCC SMAGE DISPOSAL SYSY'LI.1 FI.LC W. Owner PETER 0_'1:1ARA Address P.O. BOX 282, PAITERSON, NY Located at (Street) ROUIE 311 /CR0SS ROAD Sec. 10 Bloch 2 Wt 11 (indicate nearest cross street) i-lunicipaiity PATTERSON Watershed .CROTON SOIL, PERML MICN BEST Dt1TA I=UM D TO BE SUI3M[7TID mu APPLimriCNS Date of'Pre- Soaking 9/16/88 Date of Percolation Test 9/16/88 HOL,S IltiMM CL= TIME ON ]MOOL TICK Ito. Time Ground Surface In Inches Soil Rate Start: Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1) �. 10:30 -10:54 24 24 27 3 8 2 10:55 - 11:25 30 24 27 3 .10 3 11:2511:55 30 24 27 3 10 A S 2) 1 10:31 -10:51 30 24 26 2 15 2 10:52 - 11:22 30 24 25.875 1.875 16 3 11:22 -11:52 30 24 25/875 1/875 16 4 1KYLT91 1. Tests to be repeat:&V at came depth until alproximately equal, roil Yates are obtained .at each percolation test hole. All data to' tn_ subnittbd for review. t PW. messuranents Lo be mde fran loop of IYAe. rev. 9/05 ,�- 6" 1211 1811 24" O'HARA SUBDIVISIU,. ,res,r i rr DATA 1U)JUIRD) 'lb BC SU11.11.1'rJU) 141'111 AVIIIACATI(A 1 L)ES(3 'yr10N OF COILS EI�JOfJUNlE1i1U IN TEST HOLES! SECTION ,2 HOLE 1JU. 4 4 A HOLC 1J0. 4-46 BROWN BROWN SANDY SANDY ' 30" LOAM 36" 112" 48" 54" 60" 66" 72" 7811 84" LOAM r 311DICAIE LEVM AT WUCH GROUNDPfiTER IS E N00UN'IERED None I NDICAl.E LEVEL TO WUCH WATER LEVEL RISES AFTER BEING ENOXN'IUM N/A DEEP 110LE 013SC(MTIONS t1ADE BX : J. F. E B E R L E DATE: 9/6/88 DESIGN Soil. Rate Used 16 Mirvl" Drop: S. D. Usabl a Wed 6852 SF 116. of Dedroaus 4 Septic Tank Capacity " g Masonry AbsorpLion Area Provided By 571 L. F. x 24" wid _ ? '` Other Alt. Desiqn or Dosing Required,, -;, �' Houk: BALDWIN & CORNELIUS, P.C. Signature o hr3ciress RD 5„ Route 22 S,' m. SEAL `(� ,, 1 °80 Brews ter , New York 10509 _ ?'Fw vo ys\ti Z� N P. 0. 111S SPACC FOR USC U 11E11L111 DEPA[rMU- 11' DULY: ''• *„ kOFESS�ONI� oil RaL•e Approved sq. fl-/gal. Checked by Dale DEPARTMENT OF HEALTH Division of Environmental Health. Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # f� WELL LOCATION Stree ddress o Village City Tax Grid Number WELL OWNER Mailing Addres i :. riva. e O Public E OF WELL primary 2- secondary RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 INDUSTRIAL M INSTITUTIONAL 0 STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# C] R LACE EXISTING SUPPLY EW UPPLY NEW DWELLING ) PEOPLE SERVED /EST. OF DAILY USAGEOC6 gal C1 TEST /OBSERVATION M ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR, DRILLING DETAILED REASON FOR DRILLING WELL TYPE UvRILLED DRIVEN E]DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO .A 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 NAME OF PUBLIC'WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ,,,� SEPARATE SHEET (date) �-� (signat PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt, (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a maaperas not to degrade or otherwise ponta3maAotpe surface or groundwa Date Date of Issue: 19 . 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 Re: Property of kLTZ.N Located at M, (T) �� -rr.� %e e t =;e ,`=13103ck Lot Subdivision of P. Subdv. Lot # Q-Qr Filed Map # �i ?710 Date Q :r T. MICHAEL DALY, P.E. ' Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 ` This letter is to authorize SHENARACKN Y '111587 a duly .licensed professional engineer •V--' or (Indicate to apply for a Construction Permit for a•svparate sewage 'system, to �F serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam CoTty R Department of Health, and to sign all necessary papers on my behalf i-4 connection with this matter and to supervise the construction of said system or systems in with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, ned Countersign"_� Owner of Property P.E., R. A., # `Z Address T. MICHAEL DALY, P.E. ��- 6- 0 iJ f �L; ���, 12 -SS6 Address Town P. 0.60X243 SHENOROCK, N.Y. 10587 a4a- Ila z 69 _4Z Telephone '2-7�-_ 7 S ' -`'j Telephone . PUT NAM C O UN T Y D E PARTM ENT O F HEALTH APPLICATION FOR APPROVAL.OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant:.. .� ► z e -2) 2.. Name of Project: 3. Locatiordwc:,��TC' { 4. Project Engineer.: 5. Address: VDOK License Number: Phone: 6. jYOe of Project:' Private /Residential Food Service Commercial , Apartments Institutional Mobile..Home.Park Office Building Realty,Subdivision Others pecify) 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) requirgd? .............. 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? ......... ............................... 12. 13. 14. 15. If so, have plans been submitted to such authorities? r1 Has preliminary approval been granted by such authorities? Date Granted: ^ Type of Sewage Disposal System Discharge.�� r: ) 6ufzF* Surface Water Ground Waters If surface water discharge, what is the stream class designation ?........ " • 6. Waters index number (surface) ........... ............................... 1 7. Is project located near a public water supply system? .................. S. If yes, name of water supply — Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... 10. Name of sewage system Distance to sewage system . 1 1. Date observed: 23. Name of Health Inspector: 14. Project design flow (gallons per day) .......... 6�).C- t0 .................... 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 ,1 wetland? .. ............................... .................... ......... N 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? ..........:'.....:'.. •'b r a. 31. Is or was project site used for agricultural activ° -jiy involving application of pesticides to orchards or other crops, soli.d,-.ci`lhazardous waste disposal, l,. landfilling, sludge application or industrial:.`acti•vity? ....... YES or NO N 32. Is project located within' 1,000 feet of.existertce of abandoned landfill, hazardous waste site, salt stockpile., landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO �Y 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 16 years? b 35. Are any sewage disposal .areas in excess of 15% slope? ............ .........:.... t� 36. Tax Map ID Number ............... .............a........0........ �..t?_ _ 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. F41lure to.bomply with this provision may be grounds for the rejection of any submission. . I hereby affirm, under pens l ty of perjury, that informat ion 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 Sectlion 210.45 of the Penal Law. SIGNATURES & OFFICIAL - TITLES: Yom, iiT� 1/, )A 1,4V MAILING ADDRESS: S D2 � , T. MICHAEL DALY, P.E. BOX 243 SHENOROCK, N.Y. 4 BEDROOM COLONIAL SINGLE FAMILY RESIDENCE PCs G BATH5sIH6 L- BATH o Room BDRM #I � GL. GL. GL- HALL .F 25 G L. 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