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Home My WebLink About0377DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -90 BOX 5 IN ;y ' .1� I • J IN I z r L 16 . -, '� J r . 1' UL I PiJ'1'NA1dI COiJPT'I'Y DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE THE M PCHD CONSTRUCTION PERMIT # Located at ��7 ]* Iee-�P own or Village 4,5r .4- �SiD Owner /Applicant Name 14A? l:�, 4f, % Tax Map �_ ? Block Lot Formerly �//i�//i Subdivision Name Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD Separate Sewerage System built by eg:6 T -W7yeZ-/ Address Consisting of l Gallon Septic Tank and �(�' ZiZ/ Zip 3 Water analysis result, for sodium (Na) is m Other Requirements: g/-• a a ..uj . ining more t' an 2t�.mg/L. 9,f sodiu!n should, not,be used for Water Saannly: Publicd liT Fi?6�.ople on severely (estrictec'Addr'essi diets. Water cons ' ' ng ,/� more than 27U mg /L c f sodium she idd not lie .used/ %loo i t trtd �rateti::, or: Ll Private Supply d ge�s� 7 Building Type � &! p/fLU&M -- Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? n In 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 stand ds, rules and regulations of the Putnam n7�r ent of Health. Date: Certified by SJ ,0417 P.E. R.A. l esign Prof ssional �^ Address Ytv.am( C K 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 are subject to modification or change when, in the judgment of the Public Health Director, such revocation ification change is necessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 -� r �J . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �f Owner or Purchaser of Building Building Constructed by �; A%kXP Location -Street ' 1-3 Z 1510 Tax Map Block Lot - - ?4 . 177�_ o illage &/ /j 44 4 &V,aP /d/S) SAV, w ff 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 constrveted--- by --me whieh - -- 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. u Dated: Month Day I Year General Contra r (Owner) - Signature Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 YML ENVI NTAL SERVICES 321 Kear Street Yorktown Heights, N. . 10598 (914> 245-2800 Albert H. Padovani, Director LAB #: 93.903038 CLIENT #: 10447 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MARTUCCI, KAREN 6 FOXWOOD TERRACE PATTERSON, NY 12563 SAMPLING SITE: 6 FOXWOOD TERRACE : PATTERSON, NY COL'D BY: KAREN MARTUCCI KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 04/141199 08:42 DATE/TIME REC'D: 04/14/9q09:30 REPORT DATE: 04/23/99 PHONE: (914)-878-2591 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/14/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 04/14/99 LEAD (111S) <1 ppb 0-15 ppb 9101 ' 04/14/99 NITRATE NITROG 0.83MG/L O - 10 9139 04/14/99 NITRITE NITROG <0.01 MG /I N/A 9146 04/14/99 IRON (Fe) <0.060 MG /L 0-0.3 mg/l 2037 04/14/99 MANGANESE (Mn > <0.010 MG/L 0-).3 mg/l 2037 04/14/99 SODIUM (Na) 59.4 MG/L N/A 04/14/99 pH S. UNITS 6.5-8.5 9043 04/1�/99 HARDNESS,TOTAL O MG/L N/A 04/14/99 ALKALINITY (AS 128 MG/L N/A 04/14/99 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER S NOT) OF A SATISFACTORY SANITARY QUALITY ACtORDI NEW YORK 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% of their distribution points 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 reduce 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 Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodiom. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested, YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.903038 CLIENT V 10447 NON STATPROC PAGE 2 ------------- m ---------- m -------------- ------------ mm --------- "m -------------- MARTUCCI, KAREN 6 FOXWOOD TERRACE PATTERSON, NY 12563 SAMPLING SITE: 6 F8XWOQD TERRACE : PATTERSON, NY COL'D BY: KAREN MARTUCCI. NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 04/14/99 08:42 DATE/TIME REC'D: 04/14/99 09:30 REPORT DATE: 04/23/99 PHONE: (914)-878-2591 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL 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 0 TO HUNDREDS OF MG/L, 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 = 170 MG/L) SUBMITTED BY: Albert H. Pad%ani, M.T.(ASCP) Director ' ` ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: J, ? 4 W o o i�t /�r eL cC TownNillage: , v?) Tax Grid # Map Block Z. Lot(s)Q(7 Well Owner: Name: Address- A A r- fix Use of Well:' 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length .22® ft. Length below grade J/Q ft. Diameter 7 in. Weight per foot 17 1b /ft. Materials: _ Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout _ Bentonite j Other Drive shoe: Yes No I 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) OVC, r T loo i Vf During yielld}test(ft) !/p Depth of completed well in feet ' TZ �e, / Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surfac Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface am ao 9 Z& If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information I Pump Type Capacity. `0 Depth Ago Model &XI 'A' Voltage-230 HP Tank Type &&&fq olume � Date Well Completed 1,211,6 If Putnam County Certification No. (00-7 Date of Report 1 � ff lWell Driller (signature) I A&-"Ae't, - NOTE: Efact location of well with distances to at least two permanent Idndmdrks to be provided on a separa�heet/plan. Well Driller's Name xi//"r 0� Signature: Address: Date: ! / f 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 FINAL SITE INSPECTION Date: Inspected by: g,-, A7 Street Location Fax \„� �'� �} O.tivner _ pi/lq;=A Town PA ry.0 P'xsrb Permit # 'P — 6 G -- 93 Tivf r /3 — a_— 90 Subdivision Lot �,, 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Av D th c. Natural soil not stripped ... ...........................g... P............ d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage Svstem a. eptic t c size -1,000 ........ ). ....... other .......... A, v b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Bolt All outlets at same elevation -water tested ................. 2. Protected below frost .................. ........... ..................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box roperly set..... .. ....... ..0 �Ireno required _ 4O0 Length installed 40, 2. Distance to watercourse measured+ 00 Ft.......... 3. In st rdin I— ..... . ............................... b �" 4. Slot n accep ablb -116 -1/32" /foot ............. 5. 10 ft. from property line - 0 ft.- foundations.......... 6. De of en 0 o s ace .................. 7. T, al d ex sio ,8° ....................... 8. S ze 3/ -1' /z' diameter c ean .................... 9. th of gravel in trench 12" minimum ................... 10. Pipe ends capped ..................... ............................... �? g. PUMD or Dosed Systems t. 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........... III. HouseBuilding a. House ocated per approved plans ... ............................... b Number of bedrooms ............. 3. �?€'�Y� eX5................ IV. Well 'Lit yP-s + -j;.:$ a. Well located as per approved plans . ............................... b. Distance from STS area measured t 00 ft ........... c. Casing 18" above grade ...................... :.......................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted.... ............ ..............................0 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 .. .............................VJ4 i Frneinn nnntrnl r%r^v;APrl YES NO COMMENTS �C X ,X •v6 -. r.. T14 P a r PV1?4AM COUNTY DEPARTMENT OF HEALTH Dh "d Bivbamalaw Heab'b Slade as. CWNWL N.Y. 10512 Eybteer to rwvue Psaadt g es CE nmK_gE OF COMPLIANCE Co N FMW FOR SRWAGE DL4POSAL SYSTEM Plasma r .S O Cleaned own car VMgp ` W Sob& W r TIT: Map /3 mod � dd co r X/ Renee_ m-! >� o Date of Pdevbpa Approwl /� Torn i ds � z 576 3 Separate sewe nio syssim to cons d /Z � Ga m Sapdc Task -ad `y�JU L /.✓, �C�i y' �' G To be amOn otad by Adlhen WOW SRpp¢ 8e s�llb Ft Adlheae on Pdvats Snppb' Deed by / � ��I - Add<eea Otb•r Regaheeanta 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage di sal stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a regu ens o nom County Department of HMKh, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of H•olthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, Mks or assigns by the bulkier, that said bulkier will plat• in good .operating condition any part of aid sewage disposal system during the period of two (2) years Immediately following thed•t� Of the lan- ai of the approval Oft Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above well be bcatad ae non approved plan and that aid well will be Inst lied in aecordan with the standard ules d rpu ads of the Depart of Ith Date C Signed - P.E. R.A. _ Addn�+��`� / ?- 1-00-7 License No :/ � 635 APPROVED FOR CONSTRUCTION: This approval expires two yea if the date Alssuedn construction the building ,has been undertaken and is revocable for cause or may be amended or modified when consider ry by thner of Health. Any change Iteration of construction reqires a M per �t proved for disposal of domestic an age, a /o supply only. Rev. 1088 petit By Title PttTHAMQ COUNTY DEPARTMENT OF HEALTH I Dhbl•B d ivbomwa of BwM Seirde . Cu" N.Y. 12312 �w to Poems Peach it l aB (S�IGTE OF 00 J N PERMIT FOR SEWAGE DISPOSAL SYSTEM[ IP 0 Two or � Stibiod= Nmo �Jt F tl[CA -oa Q-164 Lot / � Tai Map 1,--;L) beak OwwadApprvold Nacres +. rLV '� Resowd_ o RevWen o Date of Pmvku App mvd Marty Addnea Tovrn� z , Da g Subdivision A Fee Enclosed 9—Inalint � Type �71A ( _ Lot Am- a M Seethe 0* Depth Vann ember d Bsioa�a Deelp Flow G PD PCHD Nolmatloa 4 Reaa4�e- dy- W-bban�P, bb mwOMed swan" Sowaryo Spdm to ealnbit d. 1 G.8. SS"* Task aa01-14 + 1 ta _ZAi � 1 � Te to eumbuttad by Waiter Sldpptrt P� Sw* hm Addrem on �waft Sttppb DttBed Other 1 reproant'.that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew • di sal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an rpu a ens o • County Department Of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be fumished the owner, his successor$. Mks or ass s by the bulkier, that said bulkier will place in flood Operatkg condition any part of said sewage disposal system during the period of two (2) yes lately following thodate Of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any r•pe�t5bt:;�t) t t the drilled well described above well ha located as Chown on the approved plan and that saki well will b• installed in carte with s and rpu a1i%ns of the Putnam County Depart nt Of wlth. Date Signed fPP E, - R.A. APPROVED FOR CONSTRUCTION. This approval expices two years from the date issued unless construction /of the building .Ms been undertaken and is revocable for cause or may be amaadad or modified when considered necessary by the Commissioner of Health. Any charge or alteration of con 4ructbn re0ukes a r��r� permit. Approved for,dkipo 1 of domestic sanitary mwagp♦,1�private water supply only. O/88 Date L B 6�' Title `C SCAL8LIllOOf!AN INCH 2 4 5 6 ;;. 3-I -a __ 34 ea -- Iso . l 170-1 1 29200 4 ur 90 7C : ;;.,.._...• ; P/0 3-1 vo 27 28," 1 •66 I q / �Q » 3B %, a I.r.+ 1.. _. 25 126. . -23 ' AC.AL N V ' 'i , - • oo �� • yt � 3.65 AC.r 3s ••-. fa • 1 .. . " • ' • g 40 , / , nu , aao 9 I AC.e� + ty lol9.ts ILL CC L 2.27 1.88 � c � yo0 zva g 41 au C:CAL MCA `• \p, Iw sRf. tss +h. 220 lio.zo \i} a5 1.6 Of 35 0 1 ,u 9 /3 `A 2.67 AC. 2.4 O1a.96 a •ii, , 17gn atb \ • , q 2.16 CAL n AC r•:. 3.2 43 4 39609 a AC.CAL 93LtT ri o 8. 1tiZ 44 n � 9 � 3T 2.2 AC. b 45? • ' ' I 't 46 : 1,46 At xoo~ a ' N .1.13 Atd 2 x 4o AC. o r 1.761.65 41 a 40 t:39 R' 38 `� , , , 9.86 AC. _ 34 • ++'• 4 • .ate �° •ro• +s p f °I 7 ac c . , , a I • u+ sot i9 47. , 33 * ri a 3.1 LSO tt , /• g� 1 5.12IAC.CAL. 3:99 AC. CAL " $ 44 o t.1 ►t �f 34AC Ci AC. r ~ 37 �` S ot4za 48 At 89 , 32 -0 �n•� ?' _ . 12-0 �, 120 \26 1.9 AC.CAL�"3G 1y�3.64 AC, CAL 49 " g S. BAC. 1.66 ;, 1.6o.c Se31`'� 4 ]60.02 , R �• b 61010 • AC • r 51 Wyly AC.CALrt� 35 6 3.3 AC. CAL. +a a� t03'' IJ2 L64 Ac +a 30 4.09 AC. s♦ • f n , N S � C a 4 �' 99 4y ��. 218AC..wr `S Ox\,yi 0 B7 •r 7'ot R� � 3 I. 6 AC. �' Z 13.83 AC.'CAL. n 34 ,.« 1J9AG,�n tip' 5 !'•- 211 ,AGCAL x3.59 AC, CA 5.01 AC. 86 85 a� r r; g � tg 161. g r ,�' rCS, 4os.0o 8 « • 33 •\ % �. L26 r 1.29 AC. no, 21CALAC �6a a` 2/ =222 AC.CAL ��•p '� ijey9 „ U4AC. a G CA aC. 84 5 ry' 29 t BI 82a� 103A 62TAG + P, ` �tP °• 8 Yr+ ' ,tiQ. E 2.16 AC.CAL rx t ; I AC. CAS 6+ 3.50 AC. 53 x 4�64s'// , g 3, , 8 2,34 1.72 „ a s .8 SIT . - 30• ? AZCA P` s AC. AC. 4 0 00 1 l23 399.91 .� �;P' r�i.'•.e �,,.• 30 s 4.67 AC. CAL. u � ►• x g p I.B7 AC. t1 J.$ • A `�. 661.M y8 � I.IT'� '+?i_' f 12 is �3° ti4'1' / ii $ACCI1q.�TI�' pp" •.40 1.26!• At 13 3.36 AC 5:0 'AC. 53 a 92 r s�� 78 ac. d A 4 2.06 AC. rq, 'Ti cA L/d b� •ter, 4a 26.75 Ac. 61 J 79 l68 5.41 AC. t9 3oo.ao ., jq9• / 54 � 6.21 AC. CAL. 8 96 AC. 1.71 AC. c L i 4 \S '� 36128 • 50 AC. I I 6La.96 6' 8 9 55 2.45 AC. LAI. 290.65 11.90 ,/.• .• 8� C. ''�. J L. i 10 ' J,� '\+ae.S4 Acn 366.`•6 '� y t � J . ,. • 5.24 AC ' 23 1' ' 1.44 A I I 5.59 AC. - eol.ia i2 57 91o� \�p1 r 26 � I6 ' p 1 4.69 AC. yyo�58 0 � 27.52 AC! szsa = 25. 1.44 AC A' 4 r 4.95 AC. �x 59 X 'a �' �-• % 9pg0 ,��o/ / Ce 66 A "Otl \•,/ 8 .p 29 a4i ; 60 r 4 57 - / 5.35 AC. CAL. ' #31,04 ' •.2.o AC. •z'612 6.49 AC.:,'s� . i • «. / 61.1 / * yp � 163.0 al � `.,•.�,�., _.. 7.47 AC. \94.1 69 a • . - r 5 rT. +• "" , 21 g 21.97 AC //' S6e.3x 193.45 /u 2.7 AC. / 103.86 AC. CAL. 1 22.2 / 20.89 AC. .. 20 P w 60 / II' 4.73 AC S ?' 61 P5 426.79 1 Nam IQ9f M :'r- ••, i•�/ '�` 62 66940 40235 I '-/ 506.62 ..-- �...�' � •.� � , r '•y;:,. 19.86 AC. C 18 I r \ 19 2.06 At 4a�•' A$$ 28.02 ' /:4�'..•' 10 16. ° '`..� r. 64 AC. 1 s9 �C. 1,00 • ` t \ 18.92 ,r 16 8 !am65' C. 4 o , I • I ! . ..:':. 1\ 454.22 Cj CAL. a J L73 Ott M '\83.92 AC. CAL. \ 1� QA 15 g l y ,a•, �. 63 1.77 A ' j/ .L , 311.0\ .+ .'; .�, 1• 690.96 1 w 11.10 AC. CAL. 3.2 85 AC. 64 I•B�31AC.1�'Y1A 6. 13 '•� A 10.58 AC., CAL q LS9 AC.1 "''° 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 1087 Dear Mr. Daly: BRUCE R. FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 45 (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 1) Engineer's. Authorization has not been signed by the property owner. r ')) Trench cover is to be noted as geotel-tile. ✓ 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. 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. Very truly yours, MO&W-Moto-I Robert Morris, P. E. Public Health Engineer RM/mh watershed •n \j11� 1 V �9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Z-2- Re: Property of Located at 2EE x kcfl %ESE 7-, 1'1I, (T) 63 Block Z- Lot Subdivision of Subdv. Lot # J Filed Map # 2-3 L t.) Date Gentlemen: This letter is to authorize a duly licensed professional engineer or r (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. , # 63T B o, 13a..�c 2Y Address Ail lo 5,5 7 i/ '77& 5 -773' Telephone Very truly yours, Signed Owner of Property Addre ,s Town Telephone ,! INAM CDU?rff DBFAI MM OF SALTS U(1 tfld.v.I llr,:1:..�d1 t3eatftf Senrleei: Gsel:•NY.11511. ; �� to Pstivlda taaolt / be submitted to the. Dpartment,,and,a written guarantee will be furnished the. owner. his sucaaas, hebSMAN by the builder, that,tald bulkier will ohce in pod oPwating conAkbn any, "' Ar o/ nW,'swaye disposal syst nl during the period of two (2) years Ful) iat ly following tMdate of the Im- artoa o1 the -approval of the;. t:irtilkaN: of Construction ,Compliance of thi Originals em . or a y. repair$ t ... the drilled well doscri0ed above will be located as thoirn on t6 approv Plan and,tliat nid well'wil Oa insta in not the at nd r Gq_US %ns Of ' the Putnam County Depart of lba h Data P.E.4:_ R.A. _ AdMe License No APPROVED FOR CONSTRUCTION This approval expiiis two years from the date,iisued uMNSs `construction of •the building ,has been undertaken and is revocable' ?or,cauw. or may li %jmended o►mo0ifiedwhen,considerid' n y'6y in : Honer Of Health: Any 'change or alteration of construction requires a new mit. Approved /or disposal of `domestic sanitary Rev. Date C` ��` Title 10/88 -- •r t 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 #?1 WELL LOCATION Street Address To Village City Tax Grid Number — _ a_ WELL OWNER Name Mailing Addres private 0 Public E OF WELL l primary - secondary m.Rg'SIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT, gpm /4i PEOPLE SERVED /EST. OF DAILY USAGE gal O REPLACE_ EXISTING SUPPLY O TEST/ OBSERVATION D: ADDITIONAL SUPPLY alww SptPLY NEW WELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE 3DDELLED []DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: U R-Ae Lot No. .4- WATER WELL CONTRACTOR: Name, - 1 '.fi �:i7 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 Gj (date) s gnature) 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 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 aamma -nner as not to degrade or otherwisa- contamina_ surface or groundwater. Date of Issue: �'�C�' �� 19 Date of Expiration 19 x.77 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well'Driller Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD WELL LOCATION ._ Street Address -� Tows[ /Village7City Tax Grid Number WELL OWNER' Name Mailing Addres p1rivate O Public USE OF WELL 1 primary - secondary m.RESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY D ABANDONED O OTHER (specify, Q AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY Q_M SUtPLY NEW WELLING 1k I PEOPLE SERVED _ /EST. OF DAILY USAGE ; gal O TEST /OBSERVATION GIADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR. DRILLING DETAILED REASON FOR DRILLING WELL TYPE CIDICILLED 13DRIVEN ODUG GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES 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 1---NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 1) SEPARATE SHEET (date) s gnature 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 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 ina—te surface 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 r PUn4AM COUNrY DEPARTKENT CF HEALTH DIVISION OF •' • ly V HEALTH SMICES.,, DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO._:... W OhR1er p Located at (Street) l0:: Block ,Z Lot 1. (indicate nearest cross stree )' Municipality Watershed",,( . ,y SOIL, PE RCM ATION TEST DATA RDQUIRED TO BE SUBM = WIM APPLICATIONS Date of Pre - Soaking Date of Percolation Test laic HOLE 11IMM C= QLATION PEROOIATION, Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min, Start Stop Drop In Min /In Drop Inches Inches Inches 1 Z'� 9 —Z'35 a 2 '2' 2 Z:'5'— l'3 ZZ. 29 4. y�' Z 3 2189- Z's-91- lo. 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. 'Depth measurements to be made from top of hole. rev. 9/85 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED lV d (lt'/�'C ? l r�c,�ii _l e► INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: `ate DESIGN Soil Rate Used Owl _ Min /1" Drop: S.D. Usable Area Provided eroV0 No. of Bedroans Septic Tank Capacity 1 Zso gals. Type Absorption Area Provided By L.F. x 24" width trench �l Other Name T. MICHAEL DALY, F.E. Signature CON C ENCINE� . ..... !� Address P.O. BOX 243 SFAI, SHIENOROCK, N. Y. 10581 �•• A THIS SPACE FUR USE BY HEALTH DEPARZMENP ONLY: Soil Rate Approved sq.ft,/gal. Checked by Date •� TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPM HOLE N0. 45 C HOLE No. HOLE NO. G.L. �EJ� 1' i- CC} 2' 3' ►I L • 4' 5' 6' �I 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED lV d (lt'/�'C ? l r�c,�ii _l e► INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: `ate DESIGN Soil Rate Used Owl _ Min /1" Drop: S.D. Usable Area Provided eroV0 No. of Bedroans Septic Tank Capacity 1 Zso gals. Type Absorption Area Provided By L.F. x 24" width trench �l Other Name T. MICHAEL DALY, F.E. Signature CON C ENCINE� . ..... !� Address P.O. BOX 243 SFAI, SHIENOROCK, N. Y. 10581 �•• A THIS SPACE FUR USE BY HEALTH DEPARZMENP ONLY: Soil Rate Approved sq.ft,/gal. Checked by Date 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-11-13 WELL LOCATION tr a Address To Village City Tax Grid Number WELL OWNER Name Mailing Ad ress 4Yivate O Public USE OF WELL - primary - secondary G-RtSIDENTIAL 0 BUSINESS D INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT -5— gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY &IEW UPP"YEW DWELLING ❑ TEST /OBSERVATION GI ADDITIONAL SUPPLY CI DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE mfiLLED QDRIVEN ODUG O GRAVEL 0 OTHER WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:¢1 Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED EPARATE SHEET (date) TOWN /VIL /CITY 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 thirt, (30) days of the completion of water well construction, the applicant shall: 1. 2. 3. Pump the well until the water is clear. Disinfect the well in accordance with the Department attached to this permit. requirements of the Putnam County Health 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 de rade or otherwise contaminate surface or groundwater. Date of Issue: 19_�� --� Date of Expiration Permit is Non - Transferrable 3/89 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date LA i 11lr I.,g � Re: Property of b6T A, ,r Located at (T)�- CTS -j►.t c�T: ,3 Bock Lot I Subdivision of 1A A Subdv. Lot # Filed Map ?j4>0 15 Date . 51ICHAR DALY, P.E. Gentlemen: - CONSULTING ENGINEER P. 6. BOX 243 This letter is to authorize SHEMAOCK H X 10587 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 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 San:�*- tary Code. Very truly yours, n e d Countersign Owner of Property �1V —P. O , j? a P.E., R.A. , # `Z�� Address T. MICHAEL DALY, P.E. Address P. 0. BOX 243 SHENOROCK, N. Y. 10587 96Q - 1�a z 62 Telephone C) �41\11 -11-� Town �k^ -7 S -`'1 Telephone 1. PUT NAM C O UNT Y D E PARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name of Project: X111 G - 3. LocatlonfyV /C: 4. Project Engineer: A 5. Address: -V�poX " � _� �t�r✓tl.c�� C �, r dpi License Number. 4 P 4-6 Phone:., 14 • —D SD - 6. Type of Project: Private /Residential Food.tervice' Commercial , Apartments Institutional Mobile Home'Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review'(SEQR)? Typg 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? ..................... "Fy LP .-��— 12. If so, have plans been submitted to such authorities? '1 d 13. Has preliminary approval been granted by such authorities? Date Granted: 4. Type of Sewage Disposal System Discharge.6y'T. > .Surface Water ground Waters 5. If surface water discharge, what is the stream class ;Vesignation ?......... 6. Waters index number (surface) T. 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 Distance to sewage system 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) .......... $�.�?C.)....................... a 2. 25. Is State Pollutant Discharge.Elimination System (-SPDES�.Permit requ.ired ?.. 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State � U wetland ?..... ...................... ............................... .. . 28. Wetland ID Number ............... ... ........... 0................ 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 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste di.i'posal, , ils landfilling, sludge application or industrial activity? ........ YES or NO 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 contam'inat,160 ..............YES or NO DESCRIBE: z , 33. Is there a local master plan or file with the town or Village? b 34. Are community .water, sewer fac.i l ities planned to be developed within 15, years? 35. Are any sewage disposal areas in excess of 15% slope? ........................ _ 36. Tax Map ID Number ...................... ..........:....•:.....J�.-: 37. Approved Plans are to be returned to: Applicant Engineer If the application is signed by a person other than the applicant shpwn 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. , . l 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, a Sectign 210.45 the Pena 1. Law. SIGNATURES & OFFICIAL TITLES: �.(�'• . ✓ _ ,.—� -. .. 'rte. , , . r �].^� . MAILING ADDRESS: iX3 SA-04 D ZoLL G BATH DRE551N& L. BATH o ROOM BDRM #1 770 HALL -" T. MICHAEL, DALY, P.E. 25 8 BOX 243 SHENOROCK, N.Y. G L. MASTER BDRM #2 BDRM #5 BDRM 4 BEDROOM COLONIAL 51NGLE FAMILY RESIDENCE SECOND FLOOR L D MUD R ROOM PUTNAM COUNTY bEP'_?^r. 1 EATING OF i�TA TAT AREA KITCHEN STUDY G G .101 �. L. L. LIVING 2 ROOM 4' S ignature &T ;? e _ BAT} DINING FOYER ROOM GL. llp-F� GL. 24 FIRST FLOOR I /8n = 1 i -0a iii � .� �� . ep.-I 1 Y43 M.L-z:,G-t7.-t7z:G lu al NPO' .7Z�:C45R S W A S. T CT vowp 17 -77 -1)77 _C5,41 Vt. > 77 .7Z�:C45R S W A S. T CT vowp 17 -77 -1)77 _C5,41