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HomeMy WebLinkAbout0379DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -92 BOX 5 1 ru ,% ` ' �:e , 1 9 ik :. PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE R W-& "Zn'; TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P l L 'I h Located at 4C 'P-1og6V16W Dk� E Owner /Applicant Name�� Formerly Town or Village hTTj�m0 0 q� Tax Map T Block Lot - I Subdivision Name 0 tA- N -A Subd. Lot # . Mailing Address F0 00�k 2"02.- r+rTrr��©ij Zip (7-5 6,3 Date Construction Permit Issued by PCHD Separate Sewerage System built by L--- b 1 �'!¢ RA Address, CIO 610A, U' ' 'Nt)?, Consisting of 1500 . Gallon Septic Tank and � � � 4 NIS6 11)�g`i Uk Other Requirements: Water Supply:. Public Supply From Address or: Private Supply Drilled by I'l l L;f Ql4 4se AIT Address i (WU FNIT%W r" Building Type Has erosion control been completed? 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 standards, rules and regulations of the Putnam County Department of Health. Date: 0I - A� " Certified by Address 54 4;0 K 'ii � �LE �"5 License # P.E. R.A. 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 mull and void when a public water supply becomes available. Such approvals ar bject to modification or change when, in the judgment of the Public Health Director, such revocation, od' cation hange is necessary. B Title: v V''L Date: �i3` �l Y� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT. Well Location Street Address: v Town/Village: Tax Grid # Map P � v Block 'Z. Lot(s) Well Owner: Name: a Address: FO �0y. 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 X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below grade 6 ft. Diameter 7 in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Y Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: A Yes No Liner: Yes K No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second , Well Yield Test _ Bailed _ Pumped 1--Compressed Air Hours �6 Yield 9 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5 u b Capacity Depth 6406 Model Gou ids S-GS►O Voltage 23 0 HP I Tank Type 5Jgbelr Volume _ tox - 36Z Date Well Completed 9h, 3 An Putnam County Certification No. 667' Date of Rep rt Well Driller (signature) 912 NOTV Exaaflocation of well with distances to at least two permanent lAndma&s to be provided on a separateeeet/pffan.' Well Driller's Name J 6 Address: ,` Z F ► A1414 Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street ^ Yorkt wn Heights; N.Y. 18598 (q14) 245-2800 Albert H. Padovani, Director LAB #: 93.102402 CLIENT #: 12225 NOW STAT PROC PAGE O'HARA, P. DATE/TIME TAKEN: 08/28/01 0000A P.01 BOX 282 DA TE/TIME REC'D: 08/28/01 10:10A PATTERSON, NY 12563 REPORT DATE: 09/04/01 PHONE: (914)-878-75�9 SAMPLING SITE: 46 RIDGEVIEW DR. : PATTERSON, NY, 12563 COL'D BY: P. O'HARA NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAS PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TBPERATURE..: < 4C COLlFIUM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/28/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 08/28/01 LEAD (lMS) <1 ppb 0-15 ppb 910l 08/28/01 NITRATE NITROG <0.2 MG/L 0 - 10 9139 08/28/01 NITRITE NITROG <0.01 MG/L N/A 910) 08/28/01 IRON (Fe) 0.103MG/L 0-0.3 mg/l 2037 08/28/01 MANGANESE (Mn) 0.031 MG/L 0-0.3 mg/l 2637 08/28/01 SODIUH (Na) i3.1 MG/L N/A 08/28/01 pH 7119 UNITS 6.5-8.5 9043 00/28/01 HARDNESS,TOTAL 96.0 MG/L N/A 08/28/01 ALKALINITY (AS 130 MG/L N/A 08/28/01 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDlN THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAP value of more COPPER value of 1.3 mg/L, else water undertaken to reduce'the waters corrosive 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 than20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street ' Yorktown Hpights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.102402 CLIENT #: 12225 NON STAT PROC PAGE 2 O'HARA, P. DATE/TIME TAKEN: 08/28/0l 09:00A P.O. BOX 282* DATE/TIME REC'D: 08/28/01 10:10A PATTERSON; NY 12563 REPORT DATE: 09/04/01 PHONE: (914)-878-7529 SAMPLING SITE: 46 RIDGEVIEW DR. SAMPLE TYPE..: POTABLE : PATTERSON, NY, 12563 PRESERVATIVES: NONE COL'D BY: P. O'HARA TEMPERATURE,.: < 4C NOTES...: KIT TAP COLlFORM METH: Ml::' DATE FLAB PROCEDURE 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: 140-3OO MG/L 0 grain/gallon = 17.2 MG/L> SUBMITTED BY: - Albert H. Padovan-j., D^. ��,u� / ELAP# 10323 BRUCE R. FOLEY Public Health Director y LORMA MOLINARI• R.N., M.S.N. Associate Public Health Director FW �� Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278.61)0 Fax (914) 278.7921 Nuning Services (914) 218.6538 WIC (914)278-6678 . Fax (914) 278.6085 Early'linterv'666u _(914) 271.6014 Presdool (914) 2786082 Fax (914) 278' - 6648 OWNERS NAME: _PC i GCS O' �A h ,[\ TAX MAP NUMBER: pr _ 2—q 2- E911 ADDRESS: �rta GE U 1 w TOWN: SON AUTHORIZED TOWN OFFICIAL: (Signature) DATE: F11 !S� The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91IVERFRM) Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 ZE Telephone (845) 2794003 Fax (845) 2794567 October 24, 2001 Mr. Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance O'Hara Subdivision, Lot # 35 46 Ridgeview Drive Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing 5 -35, "As -Built Plan," dated 10/24/01. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 10/24/01. 3. "Guarantee of Subsurface Sewage Disposal System," dated 10/24/01. 4. Well Completion Report, dated 9/13/01. 5. Laboratory Report, dated 9/24/01. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, jok&T Harry W. Nichols Jr., P.E. HWN :jmm 00- 108.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by e vi -t-) r Location - Street 2�S,aF,C Towr Village C& r c., Subdivision Name .. L_c�1 3S Building Type Subdivision Lot # Sv (S(OLi 1 represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed. as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the' failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month C7 'Day Year Q ( Signature �P Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Address: 13Dk 262, rAA dlj State N 7 Zip f 4 ?,y6 Corporation Name (if corporation) Address: ra RPX � �d.v State N1`1 Zip 11:6 L, Form GS -97 \� �� = PPOPOSED '0C DG exi IE Now CLIENT PEA F_ P, FLO. (301A FA-rT I- PS 01v Harry VI S ite 10( 2( Bre Putnam County Department of.Health Division of Environmental Health Services 'r .. . zo A,!�ro 1 as noted for conformanoo-with 7a Rule d Regulations of the Co 9alth Department. zzll�la SYgnature &.,Title•, Date Ro5e,,rv,&vl for PC-HD Approval Stamp CONSULT BRAWING TITLE AS Bul L� uo-r -S5 SCAL 13V NEW )'0 '6' )"0 DATE C. N " ICti 0 RAN DIlVi'ENSIN_CHART (in feet) 2 335:` 31 Co` 3 3391 - 5 3,2 3-73' . q W K 5' 13 322T.v 2q, 14 3 3Co2 3,0' �S S", S; . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Street Location Town f 47 fir? �cN TM# Sewage System Area -T- 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 ........................... I. Sewage System a. Septic tank size - 1,000 ......... 1,250 ......... othe b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. A outlets lets at same elevation -water tested ................: 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & Irenches e. Junction Box - properly set ........... ............................... f. Trenches d l requi e $g 556 Length installed �o 2. Distance to watercourse measured - f o o Ft.......... . 3. Installed according to plan ......... ........:...................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ .......... ...................... g. Pump or Dosed Systems 1. Size o 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. House/Building a. ouse located per approved plans......:,. a...... b' Number of bedrooms .................?..�,....... IV. Well a. Well located as per approved plans ............... ' b. Distance from STS area measured !O 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 plan.. f. Curtain drain outfall protected & dinto exist waterco g. Footing drains discharge away from STS area ........: .:.. h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 LION Date: &IA21e � Inspecte y: Owner X2,4 Permit # P — 7 :2 — 9 3 Subdivision Lot # _ 3 ' Y L1 J .1V V l ViV11V1r;1V l J l Cc' �w`s. -: ;7 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road . Brewster, New York 10509. Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 ko7— 'Aeo 7 Z — 9'3 From: Gene D. Reed Putnam County Department of Health ZFor your information For your review As discussed No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages -S iS: P.. S. tt, Tco �.4�11 Ft GL • L ✓J ♦ In the event of transmission/reception difficulties, please contact this.office at (914) 278 -6130 ext. 2261. TIR 1 r w In the event of transmission/reception difficulties, please contact this.office at (914) 278 -6130 ext. 2261. SEW- 14 -Zwuu 04:16 PM HARRY W HICHOLS 914 279 4567 P.01 .+ PirIrNAM COUNTY DEPA1t.'1b=NT OF MEALTIK DMSION Of ENVMONMLNTAL M"TB SERVICES ATTENTION . C] ADAM XGEn For; , Fill All infmatioa Must. be flslly coatpieted prior to any Trenches X iwpecdaz a being made. PL C OwHD Coasuuttioa Permit # wo :41Ew (r7 (V) --� . OwaerlApplioant NWAW. o t MA TINI 12) Block C. Lot OIL 'Pormecly — SubdhisionName:. - 0 Subdividoa Lot # 3'S is "em 'S coos lated? 1vA Date. u syetem complete? h Date: Is sp m cenrxdcted as per pleas? is wai drilled? Mb Date: is welt located u per pleas? - HA Are erosion control measures in place? I CA' the! the sritem(s), as listed, ac the above premises bas been cow and Lad I We inspected and Verified their oompietson In =cord&= with the issued PCHD Consttuetion Permit and approved piaos and the Standards, Rules and Reg da ' Couaty Department of Health '� �. a�ck o9 n Form M49 I ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date z Re: Property of Located at ST, T..✓J, cy (T ) �.g7T�i�S cr✓ lsee4ivn 3 Block . Z Lot Subdivision of��� Subdv. Lot # .3S- Filed Map .# 3 CvG `, Date Gentlemen: This letter is to authorize S,-/ay 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: &�714 P. E. , R.A. , # 7 f 35' 01 3o 2 X13 Address fi��vv &Cie � � y Zo �7. V_V - 776 5773 Telephone Very truly yours, Signed`�� Owner of Property Address Town Telephone f, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # .. e 1 L n: Street Address: To illage Tax Grid # Map 1'L Block 2— Lots) Z_ Well Owner: Name: Address: �-,l 1z.,5-(03 Use of Well: 6--�esidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served c5 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason, j for Drilling Well Type Tilled Driven Gravel Other Is well site subject to flooding? .................................................. ............................... Yes No ��- Is well located in a realty subdivision? ......................... ..rr.. /.. ....... Yes Z---No Name of subdivision Z2' d A Lot No. Water Well Contractor: ; , V.7: 7. Address: Is Public Water Supply .available to site? .................................. ............................... Yes No L---- Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed w 11 location & sources of contamination to be provided on se 7a Date: Z. Applicant Signature: PERMIT TO CONSTRUCT A WATER WE L This permit to construct one water well as set forth above, is granted under y ovisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York tate. Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat ell driller certified by Putnam County. R Date of Issue ��� Z- Permit Iss� ' g.0 cial: Date of Expiration ?-� Title: (t' Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R FOLEY Public Health Director Sean J. Daly P.O. Box 243 Shenrock NY 10587 Dear Mr. Daly:.' LORETTA MOLINARI R.N., M.S.N. Associate 'Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York '10509 Environmental Health (914) 278 - 6130 Fax (914) 278 4921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re: Proposed SSTS: O'Hara St. Johns Road, Cottage (T)Patterson, TM# 13 -2 -92 October 5, 1999 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 regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. The Permit (P- 72 -93) does not expire until December 23, 2000. 2. Complete plans for this lot must be submitted, i.e., Hybrid plans showing the Cottage and Main House SSTS designs cannot be submitted. The plan must provided all the standard requirements for an individual SSTS for the Cottage. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ly, yo /urs �J� Robert Morris, P.E. Senior Public Health Engineer II 7 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 Address o Village City Tax Grid Number WELL OWNER Name Mailing Address rivate p`. O Public USE OF WELL B<ESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED - primary 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 2- secondary 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE( REASON FOR fl REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY DRILLING RMW SIRPLY NEW WELLING 0 DEEPEN EXISTING WELL DETAILED __ REASON FOR DRILLING WELL TYPE �ILLED DRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES LIAO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 01 Lot No. C7;— WATER WELL CONTRACTOR: Name "�'. P� ;'� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L--NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH 1M7{& SOURCES OF CONTAMINATION PROVIDED W SEPARATE SHEET -J e��a (date (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 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 Department,attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise-contaminate surface or groundwater. Date of Issue: ­e c_2 199; i 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 IS WELL SITE SUBJECT TO FLOODING? YES LIAO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 01 Lot No. C7;— WATER WELL CONTRACTOR: Name "�'. P� ;'� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L--NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH 1M7{& SOURCES OF CONTAMINATION PROVIDED W SEPARATE SHEET -J e��a (date (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 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 Department,attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise-contaminate surface or groundwater. Date of Issue: ­e c_2 199; i Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUN'!'Y DEPARTMENT OF HEALTH DIVISION OF EWIRONMERML.HEALTE SERVICES DESIGN DATA SHEET- SUSSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner, Q' 1 -�q2A. Address �1 p ToA Located at (Street)-6-t-, 4k,3 S 'Qa410 See. Block cA Lot (indicate nearest cross street) Municipality �i�-� �l 1�1 , c,t , Watershed SOIL PERCOLATION TEST DATA RDoLTIF2ID TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 11 106' lw Date of Percolation Test 10 62 l�br HOLE 11;31 NUMBER CIaX TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 11:34 - 11: 3:� '2> Z 4 Z•- 3 1 3 1l' 38 i t 4 1_:�> 1-4 Z4- 1 4 5 1 tl'-ZS'- 11;31 Z4- Z- 3 2 D 1 1:32 - HAD 311:42 -(1150 �3 Z4- 2- z 6 4 11'51 - Il:sg A ZAr 5 NOTES: 1. Tests to be repeated at same depth until apprcximately.equal soil rates are obtained at. each percolation test hole., All.data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 'Z HOLE NO. G. L. 2' 3, tt• �► 4' 5. 6'c 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED 6o G u ljlm INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �: DATE: DESIGN Soil Rate Used 124=_ Min /1" Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity gals. Type Ae="N Absorption Area Provided By �_ L.F. x 24" width trench Name emu,. =0 - max & -t _n THIS SPACE FOR USE BY HEALTH DEPARTMENT 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 Tel. (914) 278-6130 Fax (914) 278-7921 December 2, 1998 Shawn Daly P.O. Box 418 Shenorock NY 10587 Re: Proposed SSTS: O'Hara St. John's Road, "Cottage" (T) Patterson, TM# 13 -2 -73 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) Proposed contours are to be shown in the plan view. Meeting current code requirement for a fill section two feet in depth. 2) Erosion control measures for the house, well and SSTS is to be shown and the detail provided. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM :tn Veg,.qy you Robert Morris, P.E. Public Health Engineer ..r-_0 W. T. MICHAEL DALY, RE. BOX 243. SMOROM N.Y. lVi-INAM COUNTY DEPARTMENT OF I3EA�` JM PIM, L A ?PROVED FOR SZD�QI N� COUNT ONLI; i u RANCH 5IDENCE