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HomeMy WebLinkAbout0517DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -39.1 BOX 6 oral F.'-A .... ,. IN J 97- . I I` I T 1' PIP. Ir'r , 00517 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMP LI CE F01? REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # - Located at 64161r me MIL,I, RAAA Town or Village Owner /Applicant Name J PAth + CAME Tax Map 15, Formerly Mailing Address I+RV11AHP 140ULDW P4NO Date Construction Permit Issued by PCHD Lot 1)1 - i Subdivision Name P4(,hAW C4AWC, Subd. Lot # 9191% Separate Sewerage System built by UPT461+ 5014 PA-- ITEj -x0H NY Zip 11-6C.5 g".q Address (L��'L @oK 4�► Wofc-5 W lehg)l Consisting of I9-6'D Gallon Septic Tank and 580 L-F- X65 Tge'1-4�fl Other Requirements: Water Supply: Public Supply From or: X Private Supply Drilled by P'r -CEEN +- raow,9D IML- Building Typed I D E�4 L,E Number of Bedrooms 4 Address Address 4- f yt flAm k e R-E-1-4`)�41 0" Has erosion control been completed? YEL) Has garbage grinder been installed? N 0 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 regulatio of the Putnam County ep ent of Health. Date: �` (� ' �� Certified by - P.E. X R.A. r (D n Professional) Address '� M1N.ToWt -+ pVD 6�t►� lcb i r�►�, % fl5o q License # 6G IM Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval. of the private water supply shall become null and void when a public water supply becomes available. Such approval a subject to modification or change when, in the judgment of the Public Health Director, such revoca 'o odifica 'on or change is necessary. B y; Ilk Title: ``- r ��G����i` � Date: 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 )0-a3 -90 Well Location Street Address: Brimstone Hill Road Town/Village: Patterson Tax Grid # Map. 16, Block 1 Lot(s)fKl Well Owner: Name: Address: Janis & Dave Soder22ist, Haviland Hollo Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _x Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 34 ft. Length below grade 33 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic _ Other Joints: _ Welded X Threaded — Other Seal: X Cement grout _ Bentonite Other Drive shoe: __X_ Yes _ No Liner:_ Yes __X_ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface - static (specify ft) 20' During yield test(ft) 525' Depth of completed well in feet 565' 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 Drillin in over )urden 10 Hit rock at 10' 10 34 DrillinQ in rock se 34 565 Drilling in rock cfranite Hydrofr cked wel 0 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volu Date Well Completed 9/2/97 Putnam County Certification No. 002 Date of Report 3/5/98 el ril r (si a ' / r NOTE: Exact location or well wttn aistances to at Least two pennanenL ianu,nz M5 w uc PivviuvU .,,, a aVt,a<aj,� �... �wr.W =• Well Driller's Na a aal S So s, Inc. Address: 4 Putnam Ave 'Rrewster Signature: —"Aj - Date: 3/5/98 1L44m T. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES ` 321 Kear Street Yorktown Heights, N.Y. 1059 8 (914) 245-2800 Albert H. Padmvani, Director LAB #:93"800829 CLIENT #: 9341 NON STATPROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~.�~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SODERQUIST, JAN%S HAVILANQ HOLLOW RD" PATTERSQW, NY 12563 DATE/TIME TAKEN: 07/10/98 00:00P DATE/f %ME REC'D: 07/11/98 09:30A REPORT DATE: 07/21/98 `PHONE: (914)-878-6879 SAMPLING SITE: 80 BRIMSTONE RD. SAMPLE TYPE..: POTABLE ' : PATTERSON, NY 12563 PRESERVATIVES: NONE COL/D BY: JANIS SODERQUIST TEMPERATURE..: NOTES...: KITCHEN TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ' DATE FLAG PROCEDURE RESULT. ' NORMAL - RANGE METHOD ` PUTNAM CNTY PROFILE . 07/11/98 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 07/11/98 LEAD (IMS) <1 ppb 0-15 ppb 12345 07/11/98 NITRATE N%TR8G 0.31 MG/L- 0 - 10 9139 07/11/98 NITRITE NITROG <0.01 MG/L N/A 9146 07/11/98 IRON (Fe) <0.060 MG/- 0-0.3 mg/% 2037' 07/11/98 MANGANESE (Mn) <0.010 MG/L, 0-0.3 mg/1 2037 07/11/98 SODIUM (Na) 4.62 MG/L N/A 07/11/98 pH 8.0 UNITS' 6.5-8.5 9043 07/11/98 HARDNESSvTOTA[ 80.0 MG/L N/A 07/11/98 ALKALINITY (AS 80°0 MG/L N/A 07/11/98 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER NOT) OF �� ' SATISFACTORY ��NITARY ��ALITY���COF�DI 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 potent.ial. iblic schools are set at 15 ppb. . Rule for Public Systems requires that 'no more distribution points have a LEAD 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 than 20 * mg/L of Sodium. For those on a moderately restricted diet,, a maximum of 270 mg/L of Sodium is suggested. YML.ENV%RONMENTAL SERVICES ` 321 Kear Street ` . Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.800829 CLIENT #: 9341 NON STAT PR8C PAGE 2 =~~~~~"~~~-~~~~~~~~~~~~~~~~~~~"~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~ SODERQUIST, JANIS HAVILAND HOLLOW RD. PATTERQN,- NY 12563 DATE/TIME TAKEN: 07/10/98 00:00P DATE/TIME REC'Q: 07/11/98 09:30A REPORT DATE: 07/21/98 PHONE: (914)-8713-6879 SAMPLING SITE: 80 BRIMSTONE RD. SAMPLE TYPE..: POTABLE : PATTERSON, NY 12563 PRESERVATIVES: NONE COLT BYV JANIS 8QDER{3L]IST TEMPERATURE..: NOTES... : KITCHEN TAP COLIFORM METH: MF / DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD SUBMITTED BY: tor ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM caner or Purchaser of Building Tax Map Block Lot &: 2 a J/q-lf. Building Constructed by �P So 131�. en 5-To 3 N� Location - Street QNO!� Building Type l 61i 5c) /V T wnNillage 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 occupant of the building utilizing the system. Date ont ay Ye Signature: Title: n( Kf60_ ��lt'% oc_C h�i �i 'l � haw ���(r�97 %Z r�r �► -��1 �' - - `�(��)��'�' -1 � `al Corporation Name (if corporation) Corporation Name (if corporation) Address: 1�'�' J�� I�JX q 3 / Address: 5 x#00 56 7a State wt-e5 /I/V Zip 0-531 State Zip 2- Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION' Date: :� 2 s 9F Inspected by: G, '�cc Street °Location -BZlNIa7o�J� R ©,412 Owners ,A,V15 Town PArr&772soy Permit # P--�t, 3 — 9 o [of TM # / — / 39. I Subdivision Lot aAAo4a -0i 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands. ............................... II. Sewage System a. Septic tank size - 1,000 ........1,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outl ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box g ropgerl set................................................... ... Len tlPre required Length installed � 7� 2. Distance to watercourse measured- a o o Ft.......... 3. Installed according t I 4. Slope of trench a tal /16 - 1/32" /foot ............. 5. 10 ft. fro prgqperty�ine - 20 ft.- fo d tions.......... 6. DeVaRl �h <30 inches o e .................. 7. Ro wed for al�io 0 % ......................... 8. Size of vel /2" diameter clean .................... 9. Depth o e in trench 12" minimum ................... 10. Pipe end capped ........................ ............................... g. Pum or Dosed Svstems ize of pump c am er ................ ..... ........................... 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/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... — IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured 4 /OD 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 plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .. ............................... i. Erosion control providid ................. ............................... Rev. 1/97 YES NO COMMENTS I /0 x 5­ �C of X X X x X Form - Dolming TRW ' %C,-G, ,r�l mj, / ! 1 Lot Atea oZ i (J 'L- pQ Fm SecfM, 0 p rulaoe Nltil�a[ ett Hrio�a Daly Plow G P D s/ f7Q PC® Nolloci tlm b Winn Is aMided. SWWWAs SowaW SAN. a OMM r Z Q OoYw Seple Took -Wt Ir 40, To be,eratfEetpd by R Address Wiltw Sh *S¢i PWft Sop* Pas Ad6ves an it wife Sew Deiced by� Lt— ��'°•• OI`wrea� 1 repretent;tMt 1 am, wholly and eompNtely responsible for the design and location of the proposed system(ps 1) that the separate sew di cal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards. ►ulas-&—nX —reoulal ions 01 ruTMM u County pepwtment 'of Health, and that on complitiop thereof Al "Certifkata of Construction Compliance" satisfactory to the Commissioner of Neahthwill be submitted. to the Department, .and o written guarantee will_ be furnished the owner, his sucoasso►s, heirs or anions by the builder, that said bulkier will pace in pod .opwating condition any. part of said .1aMlage disposal system during the period of two (2) yeas Immediately following thedste of the Issu- ance of the 'approval of the ,Certificate of Construction Compliance of the original system or any repair tow etoi 2) that the drilled well described above WIN be located as shinm on this epproved , plan and that sold well will be instal in accordance with the' sf rdol rulqs and Ipu% oil ns of the Putnam County DepertnMnt ;of leeelth. Date Sipped Addre © License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has been undertaken and is revocable for cave or may be amended or modified when considered necessary by the Commissioner of .Health.. Any change or alteration of construction requires permit. Approved fog disposal of domestic unitary sewage, ater supply only. Rev. 10/88 atey ,Gr ��,`�C BY ° Title ���6�'/�— E�!l161Q COUM DiDtAl1lO M OFERALTH �� � DlaoOolw r��W Brll� 9�eoleNr Cawed. it Y lt'il? � 10 Pivrlis lre�it r ao C ICA18 OF CODRUAM 4: :�3.-�9 he�lai at i r►1 /P-O. w� i `I - m T" . Dais �at P.ev1... Aasovil i N O 0 0 LL T ExjgTwc, WE tm I , too A ^7 S y14 2 r S��I�< 32.� y I'fE 0 1 :ON'PLAN 0001 i .$ SSTen CHART (in f t.. ) No : A B '32'- ou. 2'1'- Oil Z 52'- �° co4'- Oil CoCoI - O" -71 0j1 -1,4' - 0 .90 �- OP. I ►7' ' o'' 9 . .434'- O' I I'1 - 0 °. jo l► °�9':- 0" 116,- 0" 12 70 - o" 42' - 0 415 - 0. 14' : ems, - .0'• IS 90' DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Str @et Address Town r+m s4ro� W /l Aad Otty o n Tax Grid Number I %- 2 WELL OWNER Name M ' ling . Addre s C' its rivate OPublic USE OF WELL Q - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM b INSTITUTIONAL Q AIR /COND /HEAT PUMP ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. ❑ PLACE EXISTING SUPPLY O TEST/ OBSERVATION fId'N W SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL OF DAILY USAGE__,gal 12 ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING `A ovle� WELL TYPE DRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES A NO IF WELL I OCATED I A REALTY SUBDIVISION, NAME OF SUBDIVISION: i Ct' 00 n �] - Lot No.. WATER WELL CONTRACTOR: Name T'PjI7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES %C NO NAME OF PUBLIC WATER SUPPLY: 'VIA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PRO ®ON SEPARATE SHEET �=C -� -0i . 0 &,k2 (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 thirty: (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the 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 dri operations be contained on this property and in such manner as not to degrade or o er e c aminate surface or groundwater. AAVE Date of Issue• 19 44 Date of Expiration 19 'q2, Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 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 Street `�ddres o illage City Tax Grid Number WELL OWNER Name 7a" if e v Mailing L Add ss riv to v c� h�� a ov D '*Public SE OF WELL I - primary 2- secondary �BUSINESS USIDENTIAL D INDUSTRIAL ❑PUBLIC SUPPLY QAIR /COND /HEAT PUMP 0ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT ,gpm /# 0 REPLACE EXISTING SUPPLY SUPPLY NEW DWELLING PEOPLE SERVED3_' /EST. OF DAILY USAGE'37S"Sal ❑ TEST/ OBSERVATION Gl ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE CZRILLED DRIVEN E]DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _11t:n" i IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Q Lot No. WATER WELL CONTRACTOR: Name :7-A D Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES LINO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: -(J /A- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED % _ - °J WON SEPARATE SHEET (date signa ure 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 s a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: - -�' 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 3$ - -- f_.. - - -N !} ; BATH r �[ L96 =1J• • • .� i �1 1 > BEDROOM 4 ;�� �� DRESSING. BEDROOM 3. _ WALK 1N 13' -0" x 10' -0" ,`" CLOSET _...1 L_. -,,�� r�+ DEPAR' 'LENT OF HEAY�,Tff ' PUTM CO MASTER BEDROOM BEDROOM 2 OP a SAP , OVETJ FOR 17'-0 " 18,-8 13' o" « 15'•8" _ _ .AOUS P OUNT NLY.; EDROOMS t ST OY f t � T n SECOND F LOO R signature &Title 4828 =.-1344S F 48' • 4 KITCHEN DINING ROOM p I' MORNING pOOM M� 17' 0" r 12._0•. 1=. LIVING nOOM 1�'•O" r 1�'•O" FIRST FLOOR -t N 0', N ABOVE w ... FOYER Li n FAMILY ROOM 13' 0" ■ 17' 0" 4828 = t 144c F LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278-6108 (FAQ 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS July 24, 1996 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Renewal and Name Change Lot #1, Richard Gang Subdivision Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS ", revised 7- 24 -96. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit For Sewage Disposal System ", dated 7- 24 -96. 4. "Application to Construct a Water Well ", dated 7- 24 -96. 5. "Letter of Authorization ", dated 7 -2 -96. 6. Three (3) copies of floor plan, for bedroom count only. 7. Design Data Sheet. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN: bd cc: Ms. J. Soderquist w /enc. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Sd da Located at �l.►^as�a�� /T,�! OLu d� (T) %��i`*',�a+� Section �5� Block Lot, Subdivision of /?t C, �Q,,La Subdv. Lot % Filed Map # o� -�!�¢ Date_ -1 Gentlemen: This letter is to authorize PhARRY 0. AJiCNVL.S jk i.�. a duly licensed -professional engineer X .or registered architect (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 La��.•• ublic Health Law, and the Putnam County San± - ��ti of M,w yc tar.y Code. / 415 Cl1Vi 9,f. Countersigned: W C., �. , w 56124 � FESS10NP� P.E , R.A. , Address / �l lJ re 4 -a /� T ;q 8 -("'t0e Telephone Very truly yours, Signed 4Own er of P 1. #f Vl t 6AI D AW -4ocej x JO Address P#R &SOS AJW - Town Telephone g_7g 681 C i p(' - �m CC= DEPARuEzz ' of HEALTH DzVISi .. OF RUMaZOML HEALTH SERVIL DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NJ. Owner ,OJP. R1 C 144 R e, A AI C, Address B >2 ► k-1 5 rc-is4 . H 1L c /20. P,ATTF rZ _v✓ l S 1 '39, iv✓ i s s's 3 Located at (Street) R I hA S 7-'> Ad T N/L L R D,. Sec. - " Block - Lot (indicate nearest cross street) miaicipaiity OA % I;�Y� -141 Watershed C/'J T� IV SOIL PERCOLATION TEST DATA RDQUTI M TO BE SU&MI= WITH APPLICATIONS Date of Pre- Soaking f l 0 2 8 9 Date of Percolation Test // o z s 9 HOLE NUMBER - .. C LOa TIME PERCOLATION PERCC=CN Run No. Elapse Time -.... Start-Stop Min. _ Depth to Water Fran Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches. Soil Rate Min/In Drop 253" l7 .. 3 !/: 33 - lZ = 03 :3o 4. 5 :.3" .�.3 2 10:4o- /a: s3 '13 ?s�'. 27" 3 /o: 0 8 l4 24 ° Z71' 3 4-7 4 . 5 1 2 3 4 5 N=S: 1. Tests to be -repeated at same depth until approximately equal soil rates are obtained at each percolation test hale. All data to'be submittlad f for review. 2. Depth measurenents to be made fran top of hole. rev. 9/85 G.L. DESCP=Tr)N OF SOILS EINXDDUN*1 R IN TEST -'ALES HOLE NO. HOLE NO. HOLE NO. if I­­' 7Z , / z- I 7o- ?_5 al A Al) Y 21 /—,o A 3' S 4AIZ-2 V S/ -7'y 41 71 81 114? If, c /tr o/2- /Vv /?,)-C--/,c OR 91 TL-' V✓4 Tl-=R 10, lit 121 131 14' INDICATE LEVEL AT WHICH GIODUM&M IS ENOOMMMED A" c AIAE INDICATE LEVEr, M WHICH WATER LEVEL RISES A= BEING DEEP HOLE a3sEwATioNs mm BY: C, Rf TC H C DESIGN Soil Rate Used 16 Min✓1" Drop:, S.D. Usable Area Provided 700c> No. of Bedrooms Septic Tank Capacity I Z 5;-(-) '-gals.- %Xm C -Alc- Absorption Area Provided By 572- L.F. x 24" width trench Other -5 Ff_ _5 Y-S TF_ P-I OR A-) S _5 1A16 )?F Q L) I /Z tN1111<11-1 L 1 1-7., ro�N Name ,40)MVr 611161AI,6�1�RIAIr A 666 cSign i; nil Address 7? irq IR F146 ID DR) V, C_ SEAL (J) P4 TTY /2 -5 AZ 21 0 /V 04 THIS.,SPACE FOR USE BY HEALTH DEFARTMERr ONLY: Soil Rate Approved sq.ft;/gal. Checked by Date � � �c x�'.A. z�z c c� �c.r xv �c �' x� �» ,� ��' �>E �• �c o � ' >�c �,A. x� -x � APPLICATION FOR APPROVAL OF PLA14S FOR A WASTEWATER DISPOSA L.SYSTEH Name and Address bf:Applicant: 2. Name of Project: ro 4. Project Engineer: ..�1/ CIL r. !3.,_,_Location� /C: 'Tl'arso 5. Address: Nillbrooke Office Centi Brewster, NY 10509 License Number: S ��?. Phone: (914) 278 -6108 .6. Tvo2 of Project: .-�Private /Residential Food.Service ....Cortmercial , Apartments Institutional H6bile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject'to State Environment al-Nality Review (SEQR)? d Tvoe Status (Check One) Type I.. Exempt Type II. Unlisted. 8. Is a Draft Environmental Impact.Statement, (DEIS) required? d 9. Has DEIS: been completed and found acceptable by Lead Agency ?• ........... IVIA 10. Rame of Lead Agency ti. Is this project in an area under•*the control of -local planning., zoning, r;ficials, ordinances? ............ .......................... or other o � 2. 'If so, have plans been.suL:m.itted to such.author.i tie s ?...._... .......... 141 /A�: 3. Has preliminary approval beep granted by such authorities ?,J?T Date Granted: s :. Type of Sewage Disposal: Systen Discharge...... Surface water o u n d Waters 5. If surface water discharge, what is the stream class designation ?........ _ 3 Waters index number (surface) .. A/Z 4 ' Is project located near a public water supply system? .................. If yes, name or water supply 11V Distance to water supply /y Is project site near a public sewage collection or disposal system ?..... y Name of sewage system Distance, to sewage system Date observed:. A. 23. Name of Health Inspector: b R 2,1,s 1�r= Project design flow (gallons per day) ..................................... 005 — 2. 25. Is State Pollutant Discharge Elimination System (SPDES)'Permit required ?..�(J 26. Has SPDES Application been submitted to local DEC Office? ................� 27. Is any portion of this project located within a designated'Town or State ,��)) wetland ? .......................... ....... ..........................•.... /v0 i 23. wetland ID Number ........................ ............................... — 29. 'Is wetland Perm, it• required? .............. ............................... Has application been made to Town or Local DEC Office? .................... 30. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving application OT" pesticide* to orchards-or other crops, solid or hazardous waste disposal, landfilling,'sludge application or industrial activity? .......: YES'or NO 32. Is project located-within 1;000•feet 'of . existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or.NO Ci DESCRIBE: 33. Is there a local master plan or file with the Town or village? ...... 3�. Are com-munity water, sewer facilities planned to be developed within 15 years? 35. Are any' sewage. disposal areas in excess of 15A slope? ........................ 36. Tax:kap ID Number ........................... ............................. 37. Approved Plan. are to be returned to: ................. Applicant f/Tngineer fl::' the application�is signed by a person other than the applicant shown in Item .1, the. spplication must be -accompanied by y-a Letter of Authorization: Failure to comply with this Drovision may be grounds for the rejection °or any submission. I hereby affirm, under penalty of perjury;- that information provided on this form, is true to the best -of my knoxledse and be 1 ief. Fa Ise sta'te7tents •made herein are punishable as a Class A Xisde- ,,eanor pursuant to Section 210.45 of the Pena 1 Law. _ . J , 3TGNATURES.& OFFICIAL TITLES: iillbrVoke Office Centre ';ICING ADDRESS: Brewster, NY 10509 \ r \ \ r, wrtA \ \ \ \\ ♦y \\ .� 'GAT `� V °r O � rro exr: A\cA eNCrcCT \ \ AAA \ .e z SITE Goc SGAt - : 55D5 DE: DESIGN FLOW- I 4 13epKooM5 @ •2& 5011, RATE usp-D : I ArPl- IGAIION KATE A55ORPTION TREI` IZEGtU1 RED : 5'i PIZOVIDEV : 51G TE5T PIT 'DE 2 -O" TO L�CG�ti rKOPEIQTY L +!o �JO .O Pr2G r05EYl `. �_ PKOP05E� r. K04 Fo {CppF ✓tZA{N atiSYIrIG M -E� Trl LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914)278-6108-(FAX) 278.2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS April 5, 1990 Putnam County Health Department 110 Old Route Six Center Carmel, New.York 10512 Att: Mr. Robert Morris Re: Proposed SSDS Brimstone Road Patterson, NY Dear Bob: Enclosed are the following: 1. Four (4) prints of Drawing SS -1, "Proposed SSDS" dated 4 -3 -90. 2. "Construction Permit for Sewage Disposal System ", dated 4 -3 -90. 3. "Design Data Sheet ". 4. "Letter of Authorization ", dated 4 -5 -90. 5. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 6. "Application to Construct a Water Well ", dated 4 -3 -90. 7. One hundred fifty dollar review fee has been prepaid by the developer. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. andolph W. Laurent, P.E. 89020 /map cc: Dr. R. Gang. w/ 1 each A & C Morehouse w/ 1 each v PU IPMAM COUNTY DERARLIIEW OF HEALTH DIVISION OF E�1i VMOa4EN 'AL HEALTH SERVICE LN-DI4 I DLAL WATER SUPPLY & SUBSURFACE SEW-AGE DISPOSAL SYSMMS REVIESV Sh= - CONSTRLTTION PERMIT DATA' REVI�wc,D 64 1/� Coi��:r -,� �on� ,,�s�,�,�. r// 125 13Y: (Name of Owner) (St.-&-t Location) DOCLIMENTS Pernit Application Corporate Resolution Plans - Three sets s/s Engineers Authorization Design Data Sheet (DDS) SUBZIV SION Deep Hole Log Perc Consistent Perc Results (3) Fit Perc Hole Depth cd House Plans - Two sets Well _1Z permit; P- -S letter Variance Request Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit- R & D) Data On DDS Plans & Perni t Sine REQUIRED DMA= ON PLANS Sewage System Plan - (north arrow) Swage System Hydraulic Profile - G_a Ly F1cw Fill Profile & Dimensions - Volune D or J Box; Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OR) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow, suf f. size If PmVed Pit & D Box Shoran & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systens Property Metes & Bounds House Setback Necessary (Tight lot) House Seger - 1 /4 " /ft. 4 "0; Type pier No Bends; Ma- . Bends 45° w /cleanout SEPARATION DIST.ANCFES SPBCIFIED ON PLAN Fields 10' to P.L., Driveway, large Trees,'Izg of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (_nc. exran) 15' to Drains - Curtain, Leader, Foot_.ig 35'to catch basin,storrrdrain,piped watercourse 10' to Water Line (pits -20') 50' intermittent drainac_e course 3eotic Tanks 10' from Foundation; 50' to well .5' Well to ?r 9 U PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . Date -1- (5-gO Re: Property of ALAt\l 4 CALL I�; M �✓1/J2�I- i� �� Located at__��1��15101`I.F_ t-I1LL J/�D (T) VATT�2S )t,j Section } Block 2. Lot Subdivision of Subdv. Lot # f Filed Map # Date �J -2lo -mod Gentlemen: This letter is to authorize'O,j�I�GLp�/, a duly licensed professional engineer / or registered architect (Indicate) to apply for a Construction Permit for a separate sewage-system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health,. and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E. 1� �,AIRFI�1,1� DRIV� Address PATT�t2�r�l , N'f 12�C�� ��► �h�- 278 -��c Telephone Very truly yours, Signed Owner of Property Address Town Telephone PT- CCUNIY DEPARTMENIT OF . E• 1. • IWS1 ..'OF RNUUZENTIAL HEALTH SERVIL DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner X it K 144 P;:) (2 q n/�> Address 912)h167_1:-1,14 HILL iZ 0. P4 7 FF rZ _v✓ N✓ / -_ Located at (Street) y/j_ go... Sec.. 18... Block Z Lot 1.2Z (indicate nearest cross street) Municipality P4 7,�Y�5 .c / Watershed CIP0 T- SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMIT= WITH APPLICATIONS Date of Pre- Soaking i/ 0 2 8 9 Date of Percolation Test _///o Z/8 9 HOLE NUS - cLa:K TIME PEE ZC OLATION PER= ATION Run Elapse Depth to Water Frcm Water Level No. Time ... Ground Surface .... In Inches .. Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches. A 2 //!02 - / / %3Z :3a 24 '' 2S�L l V2. Zv IN 3 I/; 33 - l2 : 03 :30 Z�{'' .. 2.5-17" 4 5 . .. 3 /o: Sq - 11,'08 ,;,4 -74" 7_71' 3 tj 4- NOTES: 1. Tests to be repeated at same depth until approadmately equal soil rates are obtained at each percolation test hole. All data to* be suhnittmd ' for review. 2. Depth neasvrements to be made fran top of hole. rev. 9/85 27.,, 3 /o: Sq - 11,'08 ,;,4 -74" 7_71' 3 tj 4- NOTES: 1. Tests to be repeated at same depth until approadmately equal soil rates are obtained at each percolation test hole. All data to* be suhnittmd ' for review. 2. Depth neasvrements to be made fran top of hole. rev. 9/85 DESCPJ_PTT")N OF SOILS ENCOUNTERED IN TEST --MES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 7c,,,' -5 1 z_ 7o 61qA1,DY SIL7Y 2 4,9 A 31 S 4 V 7\1 41 s 14,Alo y Z/ L 51 6 71 81 /V, W. C /r 0 A 191--) 91 10, lit 121 13' 141 INDICATE LEVEL AT WHICH GROONDM= IS ENCOUNTERED 10 IVA:-: INDICATE LEVEL M WHICH WATER LEVEL RISES AEMM G ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: 6 14 / T H -C 0 C_ Is DATE: DESIGN Soil Rate used 16 - zo Min/1" Drop: S.D. Usable Area Provided 7 No. of Bedroam Septic Tank 6pacity I Z Sc-) -gals. Type C 'PA/C, Absorption Area Provided By -5-72- L.F. x 24" width trench Other pt i7 - sY.STf_: 41? poi % N1111, C9 q 1I Name 4-1,566 cSigna ., C; T7.;q_ LLJ Address 7? OR) yj E SEAL k 10\ A4 7-TF-1-2.5 0 0451t1 N4�"0 THIS '!SPACE FUR USE BY HEALTH DEPARDEM ONLY: Soil Rate Approved sq.ft,/gal. Checked by Date