HomeMy WebLinkAbout0516DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
15. -1 -38
BOX 6
00516
!y'
00516
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 3- 3724 -00062
i
PERMIT
Under the Environmental Conservation Law (ECL)
Permit Issued To:
NYSARC INC
393 DELAWARE AVE
DELMAR, NY 12054
(518) 439 -8311
GENERAL PERMIT GP -0 -05 -001
Discharge of 1,000 - 10,000 gpd to Groundwater
Permittee and Facility Information
Facility:
BRIMSTONE
64 BRIMSTONE HILL RD
PATTERSON, NY 12563
Applicable DEC Region(s): ALL
General Permit Authorized Activity: A discharge to groundwater of 1,000 to 10,000 gallons per day
of treated sanitary waste, without the admixture of industrial wastes, from on -site treatment works
serving private, commercial, and institutional facilities using treatment units or processes referenced in
Design Standards for Wastewater Treatment Works - Intermediate Size Sewerage Facilities (NYSDEC,
1988), or for facilities in the Lake George Basin, referenced in Design Standards for Wastewater
Treatment Works in the Lake George Basin (NYSDEC, 1989).
Facilities serving, or intended to serve, more than one separately owned property can only be authorized
to a government agency, municipality, or sewage disposal corporation formed and regulated pursuant to
Article 10 of the Transportation Corporations Law.
Exclusions: Activities excluded from this General Permit are facilities in special (100 -year) flood
hazard areas as defined in 42 United States Code 4001; freshwater and tidal wetlands and their adjacent
areas as defined in ECL Articles 24 and 25, respectively; coastal erosion hazard areas as defined in ECL
Article 34; wild, scenic, and recreational river corridors as defined in ECL Article 15, Title 27; or
facilities located in the counties of Kings, Nassau, Queens and Suffolk not previously authorized by GP
95 -01.
Facility Location: in PATTERSON in PUTNAM COUNTY
Facility Principal Reference Point: NYTM -E: 621.3 NYTM -N: 4594.2
Project Location: 64 Brimstone Hill Rd, Patterson, NY
Specific Activities Authorized for this Permit: This permit authorizes the subsurface discharge of
1,890 gallons per day of treated sanitary waste through a septic tank and leach field system.
Page 1 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 3- 3724 -00062
Permit Authorizations
P/C/1 SPDES- Groundwater Discharge - Under Article 17, Titles 7 & 8
Permit ID 3- 3724 - 00062/00003 (SPDES ID NYG002849)
New Permit Effective Date: 3/6/2014 Expiration Date: 5/10/2015
NYSDEC Approval
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict
compliance with the ECL, all applicable regulations, and all conditions included as part of this
permit.
General Permit Authorized by
Permit Administrator: WILLIAM R ADRIANCE , Chief Permit Administrator
Address: NYSDEC HEADQUARTERS
625 BROADWAY
ALBANY, NY 12233
Date: 05/11/2005
This permit is not effective without the signature below:
Validation under this General Permit
Authorized By: STUART M FOX Deputy Chief Permit Administrator
Address: NYSDEC HEADQUARTERS
625 BROADWAY
ALBANY, NY 12233
Authorized Signature: " Date 3 / 6 / 14
Permit Components
P /C/I SPDES- GROUNDWATER DISCHARGE
GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
P /C/I SPDES- GROUNDWATER DISCHARGE PERMIT CONDITIONS
1. Maximum Flow, Strength and Character The disposal system must not receive, or be committed
to receive, sanitary wastes without the admixture of industrial wastes that:
Page 2 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 3- 3724 -00062
a. exceed the disposal system design flow, or
b. have a strength or characteristic beyond the design capability of the disposal system.
2. Certification of Treatment Works Approval of treatment works construction by a local health
agency or certification by a professional engineer licensed to practice is New York State is required as a
prerequisite to any discharge of wastewaters.
3. Approval of New or Modified Treatment Works Discharges from new disposal systems, or
increases in discharge from the modification or replacement of existing disposal systems are not
authorized until appropriate action is taken as follows:
In locations where a local health agency has jurisdiction, required approval for on -site system
plans, design, and construction must be secured. Prior to commencing a discharge, the permittee
must submit a " Permittee Affirmation of Local Health Department Approval of Onsite Treatment
Works" to the Department's GP -0 -05 -001 Coordinator affirming that local health agency
approval has been obtained. The affirmation must include the date that the system will be
placed into service and become operational.
b. Where local health department approval is not required, at the completion of system construction
and prior to commencing a discharge, the permittee's engineer must submit a "Professional
Engineer's Certification of Onsite Treatment Works Design and Construction" to the
Department's GP -0 -05 -001 Coordinator. The certification must include the date that the system
will be placed into service and become operational.
The certification must be performed by an engineer licensed to practice engineering in New
York State, certifying that treatment works were designed and constructed in accordance with
Design Standard for Wastewater Treatment Works - Intermediate'Size Sewerage Facilities
(NYSDEC, 1988) or for facilities in the Lake George Basin, the Design Standards for
Wastewater Treatment Works in the Lake George Basin (NYSDEC, 1989).
4. Inspect Septic Tanks A septic tank installed as part of the disposal system shall be inspected by the
permittee or his agent for scum and sludge accumulation at intervals not to exceed one year's duration.
The permittee shall remove scum and sludge accumulations before they exceed one -fourth of the liquid
depth so that no settleable solids or scum will leave the septic tank effluent. Septage materials shall be
removed, transported and disposed of in accordance with applicable law and regulation.
Such inspections may be performed by the permittee, an engineer licensed to practice in New York
State, a National Association of Wastewater Transporters (NAWT)- certified inspector, or a New York
Onsite Wastewater Treatment Training Network (OTN)- registered inspector. Records of annual septic
tank inspection and pumping information shall be retained onsite and maintained for review by the NYS
Department of Environmental Conservation.
5. Maintain Facility The permittee must maintain the facility in effective working condition.
6. No Violation of Water Quality Classifications and Standards The discharge must not cause or
contribute to a violation of water quality classifications and standards as contained in New York Codes,
Rules, and Regulations, Title 6, Chapter X, Parts 700 -705.
Page 3 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 3- 3724 -00062
7. Certifying Engineering Report, Plans, Specifications The permittee must obtain a signed and
sealed copy of the engineering report, plans, specifications, and other related documents from the
certifying professional engineer and must maintain this material for inspection by the NYS Department
of Environmental Conservation.
8. Maintain Records The permittee shall maintain a copy of the engineer - certified disposal facility
plans, specifications, any engineering reports, as built drawings, required health agency approvals, and
other related documents for inspection by the NYS Department of Environmental Conservation.
9. Need for an Individual Permit The Department retains the right to require that any discharge
authorized under this General Permit obtain an individual permit.
10. Annual Regulatory Fee Permittees are responsible for payment of the annual regulatory fee billed
by the Department. Failure to pay can result in imposition of penalties or revocation or suspension of
this permit. The permittee is responsible for payment of the fee until the discharge ceases and the
permittee requests and receives Department concurrence for termination of coverage under the permit or
the Department approves a transfer of the permit to a new permittee.
11. General Permit Expiration This General Permit expires on May 10, 2015. If the permittee is in
full compliance with the terms of this permit, a renewal application will not be required in accordance
with General Condition 4, and General Permit coverage will continue in force and effect until NYSDEC
issues a new General Permit.
12. Operating in Accordance with SPDES Rules The permittee must comply with NYCRR Title 6,
Chapter X, State Pollutant Discharge Elimination System ( SPDES) Permits, Part 750.
13. GP -0 -05 -001 Coordinator As referenced in this permit, the GP -0 -05 -001 Coordinator can be
contacted at:
DEC GP -0 -05 -001 Coordinator
New York State Department of Environmental Conservation
Division of Water
625 Broadway
Albany, NY 12233 -3505
GENERAL CONDITIONS - Apply to ALL Authorized Permits:
1. Facility Inspection by The Department The permitted site or facility, including relevant records,
is subject to inspection at reasonable hours and intervals by an authorized representative of the
Department of Environmental Conservation (the Department) to determine whether the permittee is
complying with this permit and the ECL. Such, representative may order the work suspended pursuant
to ECL 71- 0301 and SAPA 401(3).
The permittee shall provide a person to accompany the Department's representative during an inspection
to the permit area when requested by the Department.
Page 4 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 3- 3724 -00062
A copy of this permit, including all referenced maps, drawings and special conditions, must be available
for inspection by the Department at all times at the project site or facility. Failure to produce a copy of
the permit upon request by a Department representative is a violation of this permit.
2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly
provided for by the Department, issuance of this permit does not modify, supersede or rescind any order
or determination previously issued by the Department or any of the terms, conditions or requirements
contained in such order or determination.
3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a
separate written application to the Department for permit renewal, modification or transfer of this
permit. Such application must include any forms or supplemental information the Department requires.
Any renewal, modification or transfer granted by the Department must be in writing. Submission of
applications for permit renewal, modification or transfer are to be submitted to:
Regional Permit Administrator
NYSDEC REGION 3 HEADQUARTERS
21 SOUTH PUTT CORNERS RD
NEW PALTZ, NY12561 -1620
4. Submission of Renewal Application The permittee must submit a renewal application at least 180
days before permit expiration for the following permit authorizations: P /C /I SPDES- Groundwater
Discharge.
5. Permit Modifications, Suspensions and Revocations by the Department The Department
reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or
revocation include:
a. materially false or inaccurate statements in the permit application or supporting papers;
b. failure by the permittee to comply with any terms or conditions of the permit;
c. exceeding the scope of the project as described in the permit application;
d. newly discovered material information or a material change in environmental conditions,
relevant technology or applicable law or regulations since the issuance of the existing permit;
e. noncompliance with previously issued permit conditions, orders of the commissioner, any
provisions of the Environmental Conservation Law or regulations of the Department related to
the permitted activity.
6.' Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or
another permit condition. Applications for permit transfer should be submitted prior to actual transfer of
ownership.
Page 5 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION is
Facility DEC ID 3- 3724 -00062
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification
The permittee expressly agrees to indemnify and hold harmless the Department of Environmental
Conservation of the State of New York, its representatives, employees, and agents ( "DEC ") for all
claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in
connection with the permittee's undertaking of activities in connection with, or operation and
maintenance of, the facility or facilities authorized by the permit whether in compliance or not in
compliance with the terms and conditions of the permit. This indemnification does not extend to any
claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or
omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New
York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state
laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee is responsible for informing its independent contractors, employees, agents and assigns of
their responsibility to comply with this permit, including all special conditions while acting as the
permittees agent with respect to the permitted activities, and such persons shall be subject to the same
sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee.
Item C: Permittee Responsible for Obtaining Other Required Permits
The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights -of-
way that may be required to carry out the activities that are authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This permit does not convey to the permittee any right to trespass upon the lands or interfere with the
riparian rights of others in order to perform the permitted work nor does it authorize the impairment of
any rights, title, or interest in real or personal property held or vested in a person not a party to the
permit.
Item E: Referenced Materials Forms and regulations referenced in this permit are available at the
NYS Department of Environmental Conservation's regional offices and on our website:
www.dec.ny.gov.
Page 6 of 6
New York State Department of Environmental Conservation
Division of Environmental Permits
625 Broadway, Albany, NY 12233 -1750
Phone: (518) 402 -9167 • Fax: (518) 402 -9168
Website: www.dec.ny.gov
March 6, 2014
Ms. Susan Limongello
Executive Director
NYSARC Inc
Putnam County Chapter
31 International Blvd
Brewster, NY 10509
Re: Facility: Brimstone
DEC #:3- 3724 - 00062/03 NYGO02849
Dear Ms. Limongello:
Aft
Joe Martens
Commissioner
Enclosed is the State Pollutant Discharge Elimination System ( SPDES) permit
reauthorization for the referenced facility to discharge 1,890 gallons per day of treated sanitary
waste to groundwater.
It has been determined that this facility qualifies for a SPDES General Permit (GP -0 -05-
001). Therefore, coverage has been changed from the Individual SPDES permit NY0233323 to a
SPDES General Permit NYG002835. A new permit term will begin on March 6, 2014 and
expire on May 10, 2015.
Please be aware that an annual regulatory fee will be assessed. Questions regarding the
regulatory fee should be directed to the Regulatory Fee Unit at 1- 800 - 225 -2566. Should you
have any technical questions on permit content, please contact the Regional Water Engineer,
Shohreh Karimipour, at (914) 428 -2505.
Sincerely,
Teresa Diehsner
Division of Environmental Permits
Enclosures
c: D. Whitehead, RPA
S. Karimipour, RWE
C. Jamison, CODOW -BWP Permit Coordinator
D. DeGraw, NYCDEP
NYSDOH District Office
,cos !P --1 80
,Lb PUTNArA' COUNTY 'DEPARTMENT OF HEALTH
`Division of Eriviroi►mental: Health -&rv►ces;:: Carmel, N. Y. 10512
CERTIFICATE ;OF :CONSTRUCTION COMPLIANCE FOR`SEWAGE :DISPOSAL SYSTEM Pd "tt2rS011 .
:. Town 'or .Village
Tax
B Onto ne' Ho11 ow Road
:Map
lock
Located at - B
i%it
owns► `Steven `arhara'Ma�irp Lot 1 21 Job. S.D. #1905'
Separate Sewerage system „built by— SiWnerc Address Br1iC1S,
tone aHollow Rd; ,Patterson N.Y.
ZOW
Consisting',-of _111usLGal. Septic Tank.-- lineal Feet X width trench
Other requirements
one
Water Supply: Public Supply From _
X . Private Supply Drilled E .p F Beal &Sons.', InG
'f Putnam A`yenue, Brewster, NY. '10509
I ddress
Building Type
Frame 'No of Bedroor{is t{1Y'1?2 Date., Permit Issued July 1984
Has .Erosion Control- Been Completed ?' yeS
jr I certify that the.system(s). as listed serving the above premises were`constri cted. essentially as shown on the ,plans of "the completed work '(copied of which are
attached), and in accordance .with the itandaids, rules and regulations, plans flied, and the permit. Issued. ,by, the Putnam County Department of Health,
16 July ' 1984 T •moo
Date'` Cert,fiedby
P.E. Fta4.
Address :.:RD.• #9, ;Fair
St , ar- '1, N.1 1051:2 Cleanse No. 29206
Any ,person occupying premises'seived by the above systems) 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 -sewer age: system shall,become,iiull.and void as soon'as 'a public sanitary sewer 'becomes
availatile,'and.the a roval ,of the private water - supply shall become -null and void when a' Pub tic water•-supp)y becomes available. Such approvals. are
PP
' subject to modification or` change ,,when, in. the Judgment of -the Commissioner -of `Health ,such evocation modification or xhange Is necessary.
i
V
Title
Date__ BY.
0.7
• K.
y
en
i�
WELL COMPLETION REPORT L, PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health,Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Thomas P. Maguire Co.
ADDRESS
Drawer L. Old Rte, 229 Brewster,NY
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
Brimstone Hill Road' Patterson' NY
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
F1 SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
EQUIPMENT
1 ROTARY ❑ A R PERCUSSION ❑ P RCUSSION ❑ (specify)
CASING
DETAILS
LENGTH ( feet)
23 9
DIAMETER(Inches)
6"
JWEIGHT PER FOOT
9 lbs a THREADED ❑WELDED
I SHOE
x YES ❑ NO
CA31AG —jTk�'
YES LJ NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR
YIELD (G.P.M.)
1
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
202
DURING YIELD TEST jfeet)
Depth of Completed Well
in feet below Land surface: 165,
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
10
Drilling in overburden
clay and boulders
10
23
Hit rock at 10 feet
10
23
Drilling in rock, set
casing grouted
23
165
Drilling in granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
3 31 83
DATE OF REPORT
7/17/84
WELL GRILLER (Signature)
i
f
I
1
1
BREWSTER LABORATORIES
Box 114 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 5490
SOURCE: Steven Maguire Faucet - Well
Brimstone Road
Patterson, NY 12563
COLLECTED: July 30, 1984
BY: John Prentiss
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This rttult irrdicattt tht source of the sample war
of tatitfactory taxitary quality whtx the tampli, was collected.
0 per 100 ml.
August 1, 198
Bickwit P. E.
Director
Steven & Barbara Magutre.
Owner or Purchaser of Building
Building Constructed by
Brimstone Hollow Road
Location - Street
Patterson
Municipality
Frame
Building Type
18
Section
2
Block
1.21
Lot
"Jean Segal"
Subdivision Name
2
Subdv. Lot #
GUARANTEE OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it 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 success-
ors, 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 initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to oper,ate.properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the determin-
ation of the Director of the Division of Environmental Health Services
of the Putnam County Department of Health as to whether or not the fail-
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system. l
Dated this 17th day of July 19 84 Signature
Title aojj !
Corporation Name if Corp.
Patterson;' M. Y.
Address
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
i
�Ta��.
Enq.incat t _ • ra--
tt�aww H(d althda,pt- t
Field inspection by: Health dept I61 dal e Q.1111+-
Eng.inee.r date: _ 7r 'F�L . -.-
NOES:.: 1 1 Is' ;r1 �. ;� ., r,<.,`•
team county llepartment of Realm f:
Division of Environmental Health Services - -
Approved as noted for conformance with
applicable Pules and Regulations of the
P County a It Department.,
1-M-E N S
.¢naturq ,4 ] l t T, tq f
A - Dr - B - D -
A - E 1? B - E -- 42
A - F - - -�D - -
- B - F
r f p
A - G = - -4f5— - 6 - C'
A j =--- -- - --e J - -- - - - -- tK .
A - - _- --8 -K ` - -= - - -- c
)WNER:_hjG -VG..I
_0 ATION _Streat: 11u, 20A_D
iUBDI I$IQN:�GArI Ga�tA. Lot t -FLEa mAP0.
31ock:ri _2.- _ = LOT Ns
Builder: o W 1 _15-72 -'
Surveyor-.[ .Fi:I rytTOo�_ —
rro -7
"'.JOH.N H,• PR ENTISS PE"
CONSULTING ENGINEER '
RD cT, Fn,z ;�-•c, CARMEL NY 10312 -(9141 R7R_g2(1
`Structure iocated from survey by surveyor n
notea be'OrW
Weil located by: Survey?rs survey. _ _ _
_ ❑�t
Welt drillers report
mrsurements. ®
®—
Tank, boars; pits, galleries 8, laterals located by:Contraetor
A - F - - -�D - -
- B - F
r f p
A - G = - -4f5— - 6 - C'
A j =--- -- - --e J - -- - - - -- tK .
A - - _- --8 -K ` - -= - - -- c
)WNER:_hjG -VG..I
_0 ATION _Streat: 11u, 20A_D
iUBDI I$IQN:�GArI Ga�tA. Lot t -FLEa mAP0.
31ock:ri _2.- _ = LOT Ns
Builder: o W 1 _15-72 -'
Surveyor-.[ .Fi:I rytTOo�_ —
rro -7
"'.JOH.N H,• PR ENTISS PE"
CONSULTING ENGINEER '
RD cT, Fn,z ;�-•c, CARMEL NY 10312 -(9141 R7R_g2(1
)WNER:_hjG -VG..I
_0 ATION _Streat: 11u, 20A_D
iUBDI I$IQN:�GArI Ga�tA. Lot t -FLEa mAP0.
31ock:ri _2.- _ = LOT Ns
Builder: o W 1 _15-72 -'
Surveyor-.[ .Fi:I rytTOo�_ —
rro -7
"'.JOH.N H,• PR ENTISS PE"
CONSULTING ENGINEER '
RD cT, Fn,z ;�-•c, CARMEL NY 10312 -(9141 R7R_g2(1
PUT'NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY..OFFICE BUILDING, CARMEL, N. Y. 10512 ..._':e,euuw ;;,4t
: ' . ....
.. Y 'm. va3
.. ...
DESIGN DATA SHEET- SEPARATE
SEWAGE DISPOSAL SYSTEM FILE NO * ".' ' c�
/, t - is
Owner
Address
Loca
Block-- ,� . Lot - z /..2/
Indicate,:. nearest' cros s. s ree °� .:> '*.: �,..... ,d� /st9•�
Munio1vality, ° �.. ,
� s: �.�,.4 3 Wactershed
.' .�,�;
SOIL PrERC01'ATI0IV TEST
DATARE�UIRED, TO BE 'SUBMITTED WITH,.APPLICATIONS .
3
Hole
'Number ...:.._... CLOCK- ._TIME .
PERCOLATION '���PERC �OLATION
Run Elapse
Depth to Water Water Level E
No...'..:., .... - Time .
From. Ground Surface in .I Soil Rate
..:.,..:..,:.;:...
Start -Stop ', Mtn.
Start Stop Drop in Min. /in drop
Notes: 1) Te`ts to..be repeated at same depth until approximate)�r
Inches Inches Inches .s..
rates are obtained at each percolation test hole.. All data to
1.6 17
for review.:'
2./O S ..... �': 17
/ll
?.r 2
4.
_ e Y
2 1e 9
3'
/, t - is
�a n .._i ,, � := 5•,.. ^i. . "r 2 ±; ?y,., k`* , -.. e.: "" a.'r" .,! *s
3
/LA �es A5.0 ale
Notes: 1) Te`ts to..be repeated at same depth until approximate)�r
equal soil
rates are obtained at each percolation test hole.. All data to
be submitted
for review.:'
?)..Depth measurements, to be made from top of hole.
1 s i
W x=p PUTN: CQUNTY DEPART OF HEALTH; Permit. P 1 T8Q
Division of. Enwronmentl Health Services Carmel N, Y 10512
CONSTRUCTIO, PERMIT`
FOR - SEWACE DISPOSAL SYSTEM'. ` pattercon
f Town r- Village
Located at Brlms't�ne Hol 1 ow`ad' P
;� ., Block Lob:,. 1 • 2'1:
Tax -Ma
Subdwision °Jean S69al , ,' t ed 1�apA ,69 -.A' Subd �t +« 2 Renewal o Revision o Job #S.,0: 1905
"4, Owner /Add ass S.teven.&. �Ba�r6ar "a- ,'Ma9ui-re. Pa�ttersoh N` X: } �. �: f .: 15�_Apri�l. 1982 ..
! ! Date .Of :Previous Approval _
BWlding Type Frame LOt area oo A Fill Section -;only ❑ -
> . -
r r' u .
Number of Bedrooms Three `Design Flow G /P /D. 600 P C H D Notification,,Required n0
,Separate `Sew.erage, System to consist of 1 ��0 Gal r Septic Tank and :321 'f t X 24�� wide 1 ateral s
To be constructed by - owner y £ Address -
d
on Hol low Rd Patterson 'N Y3
' ater SuPPIY.. ..: Public` SupPly;'From
,Prwate! Supply; to be tlrilled by cf,ange' f rdm' pall er1 es t0 tr^encheS
a Atltlress' a"
Other Requirements none
� � z
<
y z 1 -responsible location, of the proposekl system(s).; 1) that the separate sewage disposal system
A represent that;l am wholl and completely res
above ^descubed: will be constructed, as Shown on the approved amenAment there to andjn accordance with the standards, rules an regu a ions o e u,nam
ounty ;;Department of "Health; and that on',compleUon thereof a iCert�ficate of.;Construction Compliance" satisfactory.to the Cominis$ioner- of Healthwil( .
be submitted to the . Department, and'a written guarantee will be furnished, the owner, `his successors, heirs:dr assigns by the builder; that said builder wilt
plIce : in, good operating: condition any part df- said: sewage disposal system during the period'of two (2) years immediately 'following the date of the issu-
once of,rthe'approval loi.,th"e Certificate •of Constructidn 0ompllance of ,the onginal system. or an,y' repairs thereto 2) hit the:,drilled wetl;de_scribed 'above
will be located:as shown,-on the appro%i d. pian "and thit.said well will'be installed in -accordance with.,the standards; rules and regu a� ona of the Putnam
.County Department =of ^Health: -'
16 July 1984 k Av
:Date Adtlress Sign.
e PX. . R A
rant
Fa r mel N Y 206RD #9' LiNo
APPROVED FOR. CONST:RUC-TION <Thisapproval expires 'one. rom.the date '.issued unless;eo ru ion of thebuilding.h 'undertaken and is
.'revocable for :cause or •may be'amendecf'or modified when ton ered�,F nary by .the Commissions o ea A'ny schange; alter - ton of construction
requves a ne e�rmd ro pg orrd�sposal of domestic samta s age, an o� ,pr ate ^water p ly onl T ,
?Date •= Trtte
BY
Rev 9 81, t ' � , �"a � � � _z '�.'t a x. �'�af • , i �' �' � t .• ,
11
K
TEST PIT DATA REQUIRED TO•BE SUBMITTED.-WITH APPLICATION
DESCRIPTION OF SOI1..0) ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. -HOLE NO.
HOLE NO'.*
G.L.
611
1211,
2411-'
v,-
30,
3611
4-C
Soil., Rate, -.:,Us.ed S.P. Usable Area
No.--- of Bedrooms - -
7A_149iq* Septic Tank Capacity. 1600 ''Gals.' Type"
Absorption Area -Pro-vJded By L.F.x24'1,' width trench.
. ...... '1 b Other,-*-.
72 177t, 02 A# A!!n zigm zftok
anin F-i i rio
'D F
Address *40
Larneo, MY, 1w)1Z
THIS -SPACE.,*"FOR",USE^"BY,-BEALTH DEPARTMENT ONLY:
Soil, RateAppr6ved Sq. he
P
by 46
Date
rim
ndm6ni there
be .4turnished
I live; Iffsta lied
~
i o he proposed system(s),; i); that Ahe- separate siwagi dl=sal system
frin two
iecbrdaAce:-,witfi the ',standards rule_; and ired-RuNfro-n.sof the Putnam
P.
5 12
Licinve. No
ndertaken,incf- is
:'(h6 ddihrhisSibn 'i Health. A�ny 'change :br alteration of, construction -
TA
o
77 c
TZ
_4 AMACOVN%Ylli�
S0.1 905
En
-',,CON$TRQCTION'PERM IT 'FOR SEW A(M� DISPOSAL iysn RA
P.Q.06
Map
Village
Ta�K
New- 'he
owhe -0 val
..Separate- Sewerage Systernjo
;4 o be' c6hs'tru�tedr by- Foss
Date
rim
ndm6ni there
be .4turnished
I live; Iffsta lied
~
i o he proposed system(s),; i); that Ahe- separate siwagi dl=sal system
frin two
iecbrdaAce:-,witfi the ',standards rule_; and ired-RuNfro-n.sof the Putnam
P.
5 12
Licinve. No
ndertaken,incf- is
:'(h6 ddihrhisSibn 'i Health. A�ny 'change :br alteration of, construction -
TA
o
I!
PIELD C}TECK I; L'ST.
•
Date:
- Insp . by
INI.TTAL SITE 111 SPECTI.O!"
Ye 3
No
Comment.
,Property lines or corners found . . . . . . . .
_
Can estimate, house location . . . . . . . . : .
Will driveway need cut . . . . . . . . . . . .
--
Must trees be removed -note these . . . ... . .
Is deep hole representative of entire SDS area
Additional deep deep holes needed. . . . . .
_
Sufficient SDS area available considering
driveway cut, house location, separation ,
distances, etc. . . . . .
DEEP MOLD DATA
Depth:
Water elevation:
Rock elevation:
Soils 'de scr_i.,otion:
�tp,
FINAL SITU TSP'' Tt rH
II• <� ,C �S �� Ins �
by:-R ,CAP_ �
Houso located wl;er. ° srot;n on approved plane
SAS located Where approved . . ./ . . . . .
•Ien ,th of trench me , asured ? 5.
Width of trench average
Slope of the line and trenches cceptable ,
-- - -.,._
Room allowed for expansion trenches
-
Over 50 ft. from st:wamp, watercour•se ... •.
Natural soil not stripped or SDS area
iun•iecessarily graded
:-
--
10 Pt. maintained'froM prop.line. and
20 ft. .from house .• : .. :
Sep6.ration of trench from house.,.. well
_
- -etc ...follows plan , : - -., _- ;-- ;.----- :__... - -; -- ; - - -� - -� ;: - -- - - --
Nwrnber of bedroars checks
- - - --
Stones, brush, • stumps, rubble, etc. greater
than 15 ft. from nearest trench . ... ... .
15 Pt. of periplicra.l soil horizontally from
trench .. ... .:. ....
Junction boxes propel °1ZT set
Could surface run off from driveway, roads',
ground surface,''. etc. channel near SDS ... ,
area. . . . . . . . . . .
Does lot. draina ,e appoar 0. K. in area of SDS
FINAL GRADING OF SITE ACCEPTIUILT
• e 1
4
�ti
-L -3n
F I
s { - S01905
PUTNA'M COUNTY DEPARTMENT 0 HEALTH
; ,s Darision ,of. Environmenra( 46kh Servrces, di I N. Y 10512 ,
t,
CONSTRUCTION ;PERMIT FOR SEWAGE',DISP,OSAL SYSTEM °' Patterson
Town or .. village
BrimstoneiHfj' Road 18 2
i Located at ti Tax`Map Block
Subdivision "J@dn Segal ": Lot:_ #2 - .Fi]ed Map #1269 =A_ „got 1._21 _ ` ;; ,ob .501905
New: England- Concepts, _Inc': �t 1.73 Main Street
Owner Address
Frarrae` 3 OOyA �` Brewster NY 10509
Building Type r L'ot�Area a
Three 600 Ga �` r (On 1 "F1 :) 1 1:95
Number. of Bedrooms Design Flow ? Total; Habitable Space Square Feet
1;000 ' s 1
Separate Sewerage Syste'in to consist of r Gal Septic Tank and
To be constructed by Address -
Water 54pplyd Public Supply from
{
Xt w
Prate'Supply to tie dril led "tiy
AAddress �' 1
u 72'x4`x4' Gallernes To @ 241 2'� }Below Grade Tncl Ends 608'- vs 600' Req'd.
Other Requirements _
I represent.that I am,,wholly and completely :responsible for the desigwanddocation of'the" proposed'system(s).; 1) that :the separate sewage disposal system.
County'.,.Departinent •.Of:'. Health,. •and that* 66 completion thereof +a" ±':Certificate of Constructs
be subm
fitted fo •the'Department,`'and a `,written guarantee will be',furnishetl the owner 'his
-1 in ood o 'er
:pace g p, atuig condition, any past of said sewage disposal system during 'the•pei
ante of. the approval of, -the Certificate of. ConstrucUOn Compliance of the original` system
will be located a3 shown.on the approved plan and that said Well will be installed in accordance
s County Depart ment iof Health
3] March 1980
Oats
S* igned -
Aild ►ess R. 9•,. Farr St.,,`, 1,y NY 1(
APPROVED FOR CONSTRUCTION Thts approvat,expires one year from the date i ;sue "
- revocable for cause of ;niiy-be amended or modified when considered necessarg4by, 'the; om
requires :a'. new ppprmi - Approved for disposal of domestic n r sewag nd or
Date
1
0
Compliance satisfactory,to the Commissioner of Health Will
ccessors heirs or assigris`b,y the`builder; that said builder will i
Jt two (2)- years.immediately following the'dMe_of.the.Issu-
r any "repays #hereto; 2);that, the drilled well -described above
rith :the .standards,;rules and regua� irons ..oi the . Putnam
.. _ C
P.E. J 'R.A.
1"ZI License No.. 29206
ass construction of the.,building;;has been •undertaken and is
sioner' of Health.. 'Any chan9e�or' alteration of construction
Me Y only " i
.Title
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY }[EALTH DEPARTMENT
T0: Commissioner of Health , In the matter of application for
.. - - - - - - - - - --, - - - - - S- - - - _ - - - - -
�. -K S ua — _ represent
a S 1EUL�: - ,---- - -,,-- -- - -- �.-
that I am an officer or employee of the corporation and am authorized
to act for New England Concepts, Inc.
(name oi.corporation)
having offices at 173 Main Street
Brewster, New York Whose officers are
- - — — ------- ,.,,�...._,__ — ,.,----
President Robert P. Morini, 173 Main St., Brewster, NY 10509
- - ... Wame and Address)'' - -...•. ..
Vice- President
-_ - - . - _.- Namme..___._. - -_
(Name and Address)
Secretary Steven J. Kirson, 173 Main.St., Brewster, NY 10509
(Name and ,Address)
Treasurer Steven.J. Kirson, 9,73 Main St., Brewster, NY 10509
(Name and Address)
and that I am and will be individually responsible for any or all acts
of the corporation with respect to the approval remlested and all pub,
,;Aquenfi su relati qg thereto
(/ *4 - C-� ;,-,'
Sworn to b ore me th!W day Signed - 97. r,
of' Marches 19 80
Notary Public OLORES E. L4NGAN
Net K Public, State , of Nevi York
Qualified in PUtnem Couni/
commission Expires March 30, 19.0
Title
Corporate Seal
II
rYr�T,n cln.cl: 1�i: �T:
Insp . by:
INITTAL SPER IPiSPE,CTIO?' ~ �
Ycs
No
Comments
Property line. or corners found
V
_
Can cstima.tc house location .. . . . . . . .
Will driveway need cut
Nlust trees be removed -note these
Is deep hole representative of entire SDS area
Additional deep holes needed. . .
_.
Sufficient SDS area available considering
driveway cut,house location separation .
distances, etc . . . . . .
DEEP HOLE DATA
Depth:
Water elevation:
Rock elevation: �!
Soil. s' descr:i.,)tion: 1 �TVPSocL- S �®
- Date : > .
FINIAL SITU PN,SP,_CTIGTj Insp, by:
'
House located then•. shoi..n on approved plan. .
SDS located where approved . . .
--- -• -• --
'lnn th of trench mea sared
Width of trench average
Siope of tile line and - trench.acceptable . . .
Room allowed for extension trenches .
Over 50 ft. from swamp,watercourse
Natural soil not.stripped or SDS area
inuiecessarily graded ... ...
__
10 Ft. maintained from"prop.line and
20 ft. from house . . . . . . .'. . . .
Sep. ration of trench from house, well
-- etc.. - .follows plan:.
Ni'miber of bedrooms, checks . . . .. .
Stones, brush, * stumps, rubble, etc,. greater
than 15 ft. .from nearest trench
15 P't. of peripheral soil horizontally from
trench ...
_
Junction boxes properly set
Could surface run off from driveway, roads,
ground surface, etc. chal-niel near SDS
area. . . . . . . . . . . . . . . . . .
Does lot dr. a.1naF;e anpcar 0. K. in area, of: SDS
SPINAL GRADING OF SITE ACCEPTABLE
lo/ -O�
33z •03
�A.I.�
� �TI �! Ott -��: `�..` 3 �� '�- .�•.._� ,.� � --- __ _ ..
4,
ZDa
,�� (351D,