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Home My WebLink About0378DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -91 BOX 5 !7%. .. :: 16 on 90 IN � , IN J 7'' I.h4 IN ' T ` 16 rr IL t 00187 o� \\� COUNTY DEPARTMENT OF gEALTH PZTNAM � DIVISION OF .ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE T STEM PCHD CONSTRUCTION PERMIT # IJe5 7 - ry / - % p Located at e- Town or Village Owner /Applicant Name �9,9"VM1p/1y4-lw Tax Map 13 Block A Lot IFI Formerl Subdivision Name Subd. Lot # -fa' Mailing Address 10a Z ePY 3S--Z ZV Y, Date Construction Permit Issued by PCHD Separate Sewerage Systenc built by 60LI-I Cahr7r, Address /�U�r��s,, /�•�. ✓. Consisting of Gallon Septic Tank and �� ';� �.�s�� --�. % yore .4 Other Requirements: 0ps /ti2 C�c 1 P1- w/ 5462 C.-/ d7,J -a- Water Supply: Public Supply From Address or: rd Private Supply Drilled by Address , i'ews f�.��, /V Y, Building Type Has erosion control been completed? �c S Number of Bedrooms Has garbage grinder been installed? 17e 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: %7 - Certified by P.E. �1 R.A. (Design Professional) Address,�;��Ja�,ss�c,�7�s. S��i h'r��9y�:z�. C TS,/ /� if1-Y. License # e !r,$ 9 ¢ Any person occupying premises served by the above system(s) shall promptly take such action as ma# 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 a subject to modification or change when, in the judgment of the Public Health .Director, such revocatio , odifica or change is necessary. r, By: / Title: il, la"4 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange-copy - Design Professional Form CC -97 I WS, Received For f BIBBO ASSOCIATES LLP 589 Route 22 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 r` FAX (914) 277.8210 TO 71 l . WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ LL PITTIEn W TfNZA K 3WUCi" OMI DA1L JOU NO. ATILNTION � ' � 0 � RE: J the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION �= v 7 � �S — � •` e".f .SAS %S' THESE ARE TRANSMITTED as checked below: 0 For approval ❑ For your use ❑ As requested ❑. For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted • Approved as noted • Returned for corrections O 19 ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: — Lot�e�".z If enclosures are not as noted, kindly notify a of once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM V_)t►�! 1tdt,� �6��Ow �y�IK�s7, Owner or Purchaser of Building fJcfic� � doao.-V_ Building Constructed by - 1'2 5 7,r G, e � �,5;g/ �c Location - Street Building Type Z,3 Tax Map Block Lot TownNillage Subdivision Name 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 occu he building utilizing the system. t.\ Dated: Month &c, Day ,29 Year 1q717 Signature: General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Title: Corporation Name (if corporation) Address:i�C State Zip CAS p� Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Ridgeview Est., Foxwood Terrace Lot 46 TownNillage: Patterson, NY Tax Grid # /,3 - a - I'/ N, s, Map Block Lot(s)046 Well Owner: Name: Address: Dorsett Hollow Bldrs., c/o Al Finn, 15 West Hollow Rd., Brewster, NY Use of Well: 1- primary 2- secondary XX Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion XX Compressed air percussion Other (specify) Well Type Screened Open.end casing „. Open hole in bedrock _ Other Casing Details Total length 45 . ft. Length below grade 44 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: xx Steel _ Plastic _ Other Joints: _ Welded xx Threaded _ Other Seal: _ Cement grout xx Bentonite Other Drive shoe: XX Yes _ No Liner:_ _ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second , Well Yield Test _ Bailed _ Pumped XX Compressed Air Hours 6 =d 25 gpm Depth Data Measure from land surface- static (specify ft) 25 During yield test(ft) 200 Depth of completed well in feet 285 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 10 Soft fracutred limestone .10 285 Hard white limestone If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 285 25 Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 12 /6 /gg Putnam County Certification No. 2'.. Date of Report 12/14/99 Well D ' r (signa NU'm: t;xact locatlori oI well wim Qlstances to at wasi two pUMMICHL 1d11U111dRCJ w uc IJrvviucu Vila avpalU%v 71AwVwj cu.. WellDriller's t1ILL LLING, INC. Address: 75 Putnam.Me., Brewster, NY Date: 12/1Signature: :4/99 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ANI NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 JABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. 75 PUTNAM AVENUE BREWSTER, N.Y., 10509 DATE SAMPLE COLLECTED: 12/17/99. TIME COLLECTED: 3:30 P.M. COLLECTED BY: BOB MILL JR. DATE RECEIVED @ LAB: 12/17/99 TESTED BY: LAB# 11471 REPORT DATE: 12/22/99 SAMPLE SITE: DORSETT HOLLOW BUILDERS, LOT #46, FOXWOOD TERRACE, PATTERSON, N.Y. SAMPLING POINT: BOTTOM OF WATER TANK SOURCE: WELL -NEW .TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 15 Odor ND 3 Units pH 7.09 no designated limit Turbidity 1.4 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 1.65 mg/L as N 10 mg/L as N Alkalinity 200.0 mg/L no designated limits Hardness 348.0 mg/L no designated limits Iron 0.097 Ing/L 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 5.4 mg/L 20 mg/L ** Lead 0.006 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter. ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 12/17/99 SAMPLE, AS TESTED ABOVE: MPOT.ABLE or UOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 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 Tc -i�5 P. or► PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES / FINAL SITE INSPECTION Date: Street Location Inspecte y: �i pn Owner Inspected Town Permit # P-6-7-93 TM # Subdivision Lot # tlwl d p'#A7z,4 1. Sewaize Svstem 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 aa. Septic tank size - 1,000 ........1;250 .......other .............. b. Septic tank installed level., ........................................... c. 10' minimum from foundation ........ ............................... d. Distribution Box 1. All out ets at same elevation -water tested........... .2. Protected below frost ................ ....... ......................... 3. Minimum 2 ft.Original soil between box & trenche e. Junction Box - properly set ........... ............................... f. Trenches Len required 80o _ Length installed 8 6�e 2. Distance to watercourse measured -� ;I 0oFt........ 3. Installed -,cording to plan ....... ............................... 4. Slop nch a� le 1/16 - 1/32" /foot........... 5. 10 ft. om property line - 20 ft.- foundations....... 6. De Woravel h <3 i o:surface ................ 7. R 0 0� 0 ...................... 8. Si 3/4 - '' /z" iamete'r clean .................. 9. Depth of gravel in trench 12" minimum ................. 10. Pipe ends capped ...................... ............................... g. Pump or Dosed S stems pump 2. Overflow ank...�. chamber 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. House/Buildin a. House located per approved plans .................. b. Number of bedrooms ........................S... IV. Well q &4D rl a. Well located as per approved plans ............................. b. Distance from STS area measured A / ft........ 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 & dir.to exist watercoi g. Footing drains discharge away from S.TS area............ h. Surface water protection adequate ............................... i. Erosion control provided .............. ............................... Rev. 6/97 Slect Of * * PUTNAM COUNTTY DEPARTMENT OF HEALTH %'° DIVISIOIN OF ENVIRONMENTAL HEATLH SERVICES FIELD: ACTIVITY-: :REPORT - v Street _ . .Town-.- Sfate - Zip . ,PERSON IN CHARGE - NaThe:and Title ,TYPE OF FACILITY f FTNDINGS . _ 6 8 - h Ic i! VF!�Pi 4 Q11 . ;•d _ A , t F , > Signature and�Title _RFAORT RFC FT `R'V I acknowledge :receipt. }of.tlts - report SIGNATURE; ;.02/96 - .Title. _R_eV `. OFF DIMEN510NS iTEM TA NK I E5 -- - 45--2 1*5 METER P 0. G. 48.3 374 cfmijr-Z-5, Wy D-BOX 72,3*- &M Jel 80.3 73,2' (7) -# Z 06,,S' 79.2' Igo *3 '70.6 8+.7'i-- A- 115,3 1 1c, -157- #-5 jol 'r5.8 & 7 i 111.7' 107.01 6 IITI I vu;l Tf=- 3, 109 Tell?, IZ-1, 1143.8i TE-°3 ',III' W012 -rr=lw4- Vj P- L, L- ("q-5 vevl Te-*-5 7S' & 701 114, TL- 9s' - TZT. q /071 _J .. . ... ....... TE*IC.) 144J 1311 A43 ,171'!: "74" To 1 '�� -7 jP Te. 14 Ila' 15, TE Ito 571'45'41 "E 161.44 WELL 4- 1 r- PAVA uRK -1,3s -o QV. I 01 Fox WOO E) T E R Fp,,,4\ gooFr 24, A*,qp FIF-L-cs iNsTA�w-SE2: door Tj IN 06 Sy 5T Et4 IN -.51 T A LILL-D eiy: 96 M 60N'C)Tf& VCJrL-4 THIS IS TO CERTIFY THAT THE SEWAGE+SYSTEM WAS-CONSTRUCTED �jL.Ma5, My, jAS INDICATED ON THIS PLAN AND WAS INSPECTED UNDER MY ,SUPERVISION BEFORE IT WAS COVERED OVER. THE SYSTEM WAS ^%CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND dREGULATIONS OF TILE PUTNAM COUNTY DEPARTMENT OF HEALTH aZAND THE NEW YORK STATE DEPARTMENT OF HEALTH. M-17, se?o c-cy-P, Pirz-r- I AJ4.r I OF NEpp 1.6 S II METER Fox W GbD TERRACE 0'kAtZA :5V1310)." FATrE-F50N, NY cfmijr-Z-5, Wy 4co - Z lit (7) C14 Igo -157- -J. Q11 I 01 Fox WOO E) T E R Fp,,,4\ gooFr 24, A*,qp FIF-L-cs iNsTA�w-SE2: door Tj IN 06 Sy 5T Et4 IN -.51 T A LILL-D eiy: 96 M 60N'C)Tf& VCJrL-4 THIS IS TO CERTIFY THAT THE SEWAGE+SYSTEM WAS-CONSTRUCTED �jL.Ma5, My, jAS INDICATED ON THIS PLAN AND WAS INSPECTED UNDER MY ,SUPERVISION BEFORE IT WAS COVERED OVER. THE SYSTEM WAS ^%CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND dREGULATIONS OF TILE PUTNAM COUNTY DEPARTMENT OF HEALTH aZAND THE NEW YORK STATE DEPARTMENT OF HEALTH. M-17, se?o c-cy-P, Pirz-r- I AJ4.r I OF NEpp 1.6 S IZ-17-qq Fox W GbD TERRACE 0'kAtZA :5V1310)." FATrE-F50N, NY cfmijr-Z-5, Wy 4co Putnam County Department of Health Division of Environmental Health Servioss .Approved as noted for oonformanoe with applic a lea d Regulations of the epartmentr S? Lure & Title ff. i r�c:rvc.�n c� f SECTION THRU FILL FAD o� NTS F s �d •: 16.44' - g-I 1 4541" i 1f� 510 AC, . LL � / • O SSDS " tNITNIN';�100' HOUSE -. 512 SILT 3 ;=ENOE TYP, 411 1250 :GAS.. 118 T. MASONRY° 506 TANK GA5T . .GRAM _ ►^I /• S ON GoNC ' ELOYV TLINE y , % 4" 8 T -- 10 / 504 / 2 SHWN LU lu Q' / i .Q. LEADER' - .•� ` /'�t�+ � \� / -'y� .' � t k � � � •: � FOOTING unty Department pi.. Pee Itly DRAIN' hviro=ental Heal S rv�e % y - '. / �a�' DI "SGH.- noted for,.confo qc with rules and Hegu ti t19 -Title to Q N �.�w � ��Q�' •. gym. x 565 t4'33 "E .. nd: T. j PP"OYEO.!rpR CONSTRUCTION- This III)WOys: fr' fit v I OXF, as two V P' , '" two revocable for cause rrt;*� or modified h. .0 n 11111 Of '"Y I d'i d - o ag !"W"es a • :'Apg�!oved' of sg��: 9 mod. Rev. permit 10/88 0 ORWDOUANCIL "n Ahit�4&id'bulltlim will p tlie'date of 'Witii described above %a of the Putnam conslfujtiih of the liui(dinghas . beoiK urklertikon and is if of Hult'k -:�k . ny':cha n90 or alteration of construction r .Kipply only. ,Title V) �-0 DEPARTMENT 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 46 (T) Patterson Dear Mr. Dah•: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been,completed. Comments are offered as follows: `'The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Engineer's authorization has not bee signed by the property owner. Fefi ✓2) Trench cover is to be noted as geotextlle. J3) 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. ✓4) Plan has not been signed and sealed by the design engineer. J5) Remove or cross out fill settlement note. This is not applicable for fill sections 2 feet or less. ✓6) Add fill specifications, i.e., the % allowed to pass a 100 and 200 sieve. "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." Upon receipt of a submission, reNised to reflect the above, this application will be considered further. RAVmh watershed Very truly yours, Robert Morris, P. E. Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSDS: Macaluso Foxwood Terrace, Lot 946 (T) Patterson, TM# 13 -2 -91 Dear Mr. Daly: May 8, 1998 BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "'The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1• 1) Proposed contours are to be shown. 2) Current codes requires that fill is placed is the expansion area. 3) Expansion trenches are to be shown. 3) Trench detail is not correct. Minimum distance from the bottom of the trench to rock is 5 feet and to water is 4 feet. Revise accordingly. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Ve truly yours, Robert Morris, P. E. Public Health Engineer R�vl:tn DEPARTNIENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 18, 1998 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSTS: Macaluso Foxwood Terrace, Lot #46 (T) Patterson, TM# 13 -2 -91 Dear Mr. Daly: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. 1) Fill is to be shown extending 10 feet past the edge of the trench and then sloping 3:1 to grade. This is required for the primary and expansion trenches. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Very ly yours, Robert Morris, P.E. RM:tn ` Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Property of 61i /✓%LyL 0JS- -6 Located at (T) f�TSdr/ - !', Block 2 ., Lot i Subdivision of Subdv. Lot # 7(P Filed Map # Date Gentlemen: authorize "A a duly licensed professional engineer ford' - - -� ^a (Indicate . to apply for a Construction Permit for a separate sewage system, to above noted property in accordance with the standards, or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf connection with this matter and to supervise the construction of said in conformity with the provisions Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: &el-n � S_ P. E., R. A., # /p, 0, , 'go-)( -47 P, Address � ',LRLv& , )uy 7 9/41 776 -- S� 73 Telephone Very truly yours Signed Owner of Property / /--5 —//0 Address Town Telephone RIP6E -IEW Df�l�/ $ .: e. c Ln VEWfi�Y TO - _ —_ - - -- - -- — _�_ - - - -� Q _ rti p a C Uj o\- j ulu ° *k \\ 1\ . i\ \\ \\ \\ \\ O.0 rn it �1 > Ul 392 524° 5'21'A d 4 W r O tP 7i tit 3: rj w ` J n 1n m be uOnttied ' l to mace sit; yo' b no at- te app will aiioitim'is County Date APPROVED FOS revocable for cau mquirn a'. new.j Rev. 10/88 0 13 the Commissioner of Heelthwill No bulkler.,that aid builder will j following thedliti Of the INU- Fhe itriiiiii will."scribm above .r — of the. Putnam iiStruction.of.th4 building ,has been 'undeita6n and is of Health. Any change or alteration of ,construction uppty'Only.. 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 # fll :4 WELL LOCATION Stre t Address own Village City Tax Grid Number 3 --D. WELL OWNER Name Mailing Addres ,private Z a O Public S OF WELL primary 2 - secondary SIDENTIAL 0 BUSINESS 10 INDUSTRIAL 0 PUBLIC SUPPLY O AIR /COND /HEAT PUMP 13 ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify d INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE � O Bal REASON FOR DRILLING ❑ REPLACE EXISTING SUPPLY 9-NEW S PLY (NEW DWELLING O TEST/OBSERVATION. . 12-ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 0, WELL TYPE �RILLED ODRIVEN [-]DUG GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES A,-` NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: .� Lot No. (Q WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE.TO SITE: YES i-�N0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MZ_N SEPARATE SHEET to f (date) (idifnature 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 aAanner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19�� --T Date of Expiration 19 e-7,;—" `Permit Issuing Official Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH b DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at (T) Section Block Lot Subdivision of U bd,�Uo S 0 N Subdv. Lot # Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. O. BOX 243 This letter is to authorize SHENOROCK, N. Y. 10537 a duly licensed professional engineer o„ r = teiaod (Indicate to apply for a*Constructioii 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 (::::P_ C:A�� Owner of Property Countersigned: 10-T 'T� P.E., R.A., Address 7. MICHAEL a Ali 'I" P.E. p L Address Town F. O. BOX 243 SHENOROCK, N. Y. 10537 � -% Sr S �- /,,// Telephone Telephone I rapiesen;%that 1: am'4 Is. for the hesigh Ai� "lion of the proposed system(s); I). I . hat *the Sol Siren, above described will be constructed sis shown on the approved amendment there to and inaccordancswK6 the standisras. ruses arm regulations or ins, ruinam County -'Depildmint 40- H6Rl.% and that an c-iMpiatia;n thereof's .!Certaiicaite of, Construction Compllanca`* satisfactory so tim Commissioner at . Multhwill bi, submitted to and *j� j�jjttssjj "grantee Will be furnished the ov�ftsir, his kkaNW16 heirs or an"s by the bul . IsW that said builder will iiii, tpow-lition! siriy -pe I disposal 4�iltifn,'duknj the period Of two (1) 'ears Immediately following . the date of the Issu- alms of th's',apli sil,:;of theCertlikate W.C, , 011'. tit c any r s thereto. 2) that this dr ,.qv onstruction Compliance a original system a Illed well describsid above .wW be, occatei as swou".01s,ithe approved, plinind that Said *011 will'be Intl JW in h I 1� rules and reouMM51 of' Isis Putnam ` County �-_ ` Addis a -License oYJt2df APPROVED FOR. CONSTRUCTION: This approval ex , pires two years, from the date -issued unless constructW/n of the building has been undertaken and I$ revocable I . of c I ause -6e srnfinded'orm�6dlfiissl when considered no'comr - y by. the Commissioner of I Multh. Any change or alteration of construction "quires a new permit' Approved for.44"I of dornestle sanitary. mrsage. a ater supply only. � \"U88 | �' ' - - ---------�- --------' -- ------ --'--- - - - ' ' - ---- --'-- - | � ' ' o � 'vii: 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 #t� WELL LOCATION Stree Address Town Village City Tax Grid Number WELL OWNER Name t Mailing }7. Address tVIIA7. ivate ❑ Public USE OF WELL 0 - primary 2- secondary G- RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT__fj__gpm /# ❑ REPLACE EXISTING SUPPLY O-W. UPPLY DWELLING PEOPLE SERVED /EST. OF DAILY USAGE al ❑ TEST/ OBSERVATION 11 ADDITIONAL SUPPLY ❑ DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE EYRILLED ODRIVEN ODUG OGRAVEL . 0OTHER 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 �l :i7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 4___NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED IOWSEPARATE SHEET (date) ( 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 third- (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 gde de or ot herwise contaminate surface or groundwater. Date of Issue: 1Date of Expiration 1Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: -Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DESIGN D= SHEET-SUBSUEWE SEWPM DISPOSAL SYSTEM FILE NO. Owner 1016aA e-v-�.,6166dress — -Rel Located at (Street)'Ex7mik 7; it 0 Block Iot •ndicate nearest cross street) @) • m • DI 00) fl.'4 V (01k N V DF-1 I I ,IV V U TIM* ; rMov I MT Date of Pre-Soaking Date of Percolation Test 3''Q• - ja 3 2,36— 2'6�1 i(o Zq SOLE NUMSM CUXK TDIE LATION PERCOEATICN FM Elapse Depth to Water From Water Level No. Tim Ground Surface In Inches Soil Rate Start-Stop Min, Start stop Drop. In Min/In Drop Inches Inches Inches 1 %*z0 Iq 7�I��4 7if3 �3id- 31��.. 2 Z 9 14 71 3''Q• - 3 2,36— 2'6�1 i(o Zq 4 5 Z. q -:L- 4 5 MM: 1. Tests to be repeated at same depth - until approximately equal W soil•rates are obtained At each test'hole. All delta to' be A3bdttdd" for review. 2. Depth measurements to be made from top of hole. rev. 9/85 r DoT" !�0 4 � TEST PIT DATA REQUIM TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. to HOLE NO. HOLE NO. G.L. 2' .l 3' 41 �I 5' 6' 7' ' 8' 9' 10' 11' 12' 13' 14' INDICATE LE VEL'AT WHICH GROUNDWATER IS EN00UNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENODUNTERED -- DEEP HOLE OBSERVATIONS MADE BY: 1 ,ty, DATE: Z� DESIGN 1'L� �o ')4Q Soil Rate Used in /1 it Drop: S.D. Usable Area Provided No. of . Bedroans 4 Septic ink Capacity 2 SD gals. Type�pi1 Absorption Area Provided By L.F. x 24" width trench t Other Name T• MICRACL DALY P Signature �t Address P. 0, BOX 21'INGI:R SEAL f I) THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved - sq. f t/gal . Checked by T. MICHAEL DALY, P.E. BOX 243 SHENOROCK, N.Y. 4 BEDROOM COLONIAL 5 I NGLE FAMILY RE51 DENGE 24 SECOND FLOOR - 1/8" = 1' -0" I /0" = 1'-O" 1A 24' G BATH DRE551 N6 L. BATH 0 ROOM HALL 25 &)550RM MASTER BDRM #2 BDRM SECOND FLOOR - 1/8" = 1' -0" I /0" = 1'-O" 1A 24' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date i Re: Property o Located at ,M ( T ) Seetie4*Block Lo t�l _ Subdivision of E- �/�.1Zf.. 4 Subdv. Lot # Filed Map # 2 ?jCpO Date) e :T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P.O. BOX 243 This letter is to authorize SHENORnl'KJN y, �ns87 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 accordanbe 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. Countersign / P.E. , R.A. , # `Z T. MICHAEL DALY, P.E. Address P.0. BOX 243 SHENOROCK, N. Y. 10587 Telephone Very truly �yours, ned C1.) Owner of Property P. a , j? - Address 1 Town Telephone S - ..__ I P U T N AM C O U N T Y D E PART K E N T O F H EA L TH APPLICATION FOR APPROVAL OF PLANS 1�FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: �• (�� t�AT�/'� rV� . 2. Name of Project: 3. Locatiori(`*V /C: 4. Project Engineer: �� _ 5. Address•: x� License Number: �� Q�w. Phcine: 6. TyDe_ of Project: 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 Rev 6w (SEAR)? Tyae Status (Check One) Type 1.. Exempt _ Type II. Un 1 i sted S. Is a Draft.Environmental Impact Statement (DEIS) required? ............. I•�A 9. Has DEIS. been completed and found acceptable by Lead Agency ?'........... 10. Name of Lead Agency 11. Is this project in an area under the. - control of local planning, zoning; or other officials, ordinances? ...... ...... ................ ... - F0�-pu -09pr' . � b 12. If so, have plans been submitted to such authorities? ............a...... 13. Has preliminary approval been granted by such authorities? Date Granted: ^ 14. Type of Sewage Disposal System Discharge.'?i:�'�> 6v LF' 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 19. 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: A. Project design flow (gallons per day) .......... C 0 .................... 2• 25. Is State Pollutant Discharge Elimination System (SPOES) Permit -required ?:. b 26. Has SPDES Application been submitted to local DEC Office? ............... 21. Is any portion of this project located within a designated Town or State } wetland ?..... .... ... .................................................... N i 28. Wetland ID Number ............................ ..........................: 29 Is Wetland Permit required? .......... .. .... .... ... .................... Has application been made to Town or Local DEC Office?, .................. ` b 30. Does project require a DEC Stream Disturbance,Perihit? .............::: °... ` 31. Is or was project site used for agricultural activity involving application of pesticides to'orchards or other crops, solid or hazardous waste disposal, +� b landfilling, sludge application or industrial activity? ........ YES or NO N 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?_ 35. Are any sewage disposal areas in excess of 15X = slope? .... :................ ...... �[ 36. Tax Map ID Number ....................... 7. 31. 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 tb.,cchply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant,-..o Section 210.45 of the Penal Law. / SIGNATURES & OFFICIAL TITLES:- MAILING ADDRESS: r O rn rn DRIVEWAY TO RIDGE IEN Pf;ZIVE2-' M � r�� Cl > m > Ul U, rp O Lu uir\\ w CA >> 524- 5'21IN tj U ul -0 M > ILU O C% ?a � r�� Cl > m > Ul U, rp O