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HomeMy WebLinkAbout0553DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -21 BOX 7 I INNS I'm a is :: ;� r :�' ' 16 -. ' r 4y - b r � , 00553 � YJ PUITUM COUM DBPARTNMr OF H ACTH —� i I Deem= d irbesmadd Hed& Services. Cassel. N.Y. 10312 weer to Pa rvlds Pack / .. ` oa CERifFICA_ TE OF / CO , . N PWM FOR =WAGE DWOSAC SYSTEM Imabd st e, of WNW S.b&,Mn Pass "-."4 Cat N Tm Map Bbek alt Renews[ ❑ Revid n ❑ Owaar /AppYcaat Nsae CGIi�'y�w �i�7r� -. P .GUi //�ot�c' �T � Dste of Prevloas Approval M� Address 0J�rAkrh ire', ✓0J.ir T A-,,,e,U..,� %a %=— iLt�-leht..�C� !a— Town 7Jp GvSS -36 d Date Subdivision �.A %wro //ved S '�-��O Fee Enclosed R� Type G S "flips, /ft a % cot Area FE Seed= 0* LJ DV& v wm Nss dm of Bedtooau Desku Flow G P D o PCHD NoMaden Is Repa4ed-When FM'b eomplided Sepaeais SewMy Systems b emu" of rllO —GAm Saptic Tech and JS jiF A its To bs eaasI cted by Addrese Water SW* : Poblle Sqq* Faeet Address '2>12' an -Y—Pdaft Swb DAM by. Other R"..drements L Q t, 2u PJ Pal, 1 represent that 1 am wholly and completely responsible for the design and location of the Proposed syltem(s): 1) that the separate laws" dispoal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a reau ons o . ream County department of Hsahh, and that on completion thereof a '•Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be County to the department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that said bulkier will place in good operating condition any part of said fawage disposal system during the per iod of two (2) yews immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto: 2) that the drilled well described above will M located as shown on the approved Plan and that said well will be Insta in accordance with the st r r Ns and rpu amens of the Putnam County department of H"Ith. Date /2 .? Z r1s t S' reed P.E. k�_ R.A. J Address License No APPROVED FOR CONSTRUCTION: This approval expires two years from the data issued unless construction of the building .has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction pp requires a permit. Approved for disposal oof' domestic sanitary , a or ter supply only. n C7 date .G ��C✓ g 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 #,P-/ WELL LOCATION Street Address tf rs� illage City Tax Grid Number rDr WELL OWNER Name Mailing Address AlPrivate O Public USE OF WELL 0 - primary 2- secondary l: RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP D ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT $ gpm /# PEOPLE SERVED_S� C /EST. OF DAILY USAGE OO al REPLACE EXISTING SUPPLY O TEST /OBSERVATION d ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE QUDRILLED DRIVEN ®DUG ®GRAVEL. 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name '%� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: /\4 TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (si nature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to 'assure that any and all water or waste products from such well drilling operations be contained on this property and in suc a manner as not to degrade or otherwise contamin urface or groundwater. Date of Issue: 3 19 « / Date of Expi on 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 . 48, SECOND FLOOR DINING BOOM 13' 0" r 12'•0" 4828 = .-1344S F 48' Jt� 1 Z(\ NIT DEP Tq.tENI T+ Off HEAT,I KITCHEN SP P �`" APA ' ;V D FOR * cJ; � i �J p Lr (_'0 j 0046' j� ROOM r .:EDROO �;S ' fC N VE LIVING ROOM ' w f FAM1LY ROOM 1 3..0.. x 1 •'.0.. 13' 0" ■ 17' 0•• FOYER l FIRST FLOOR 4829 = 1 .1 a4� F 1 '• "' BATH = BEDROOM 4 y' DRESSING- BEDROOM 3. WALK 131-0- x 10 %0" IN t� CLOSET �r MASTER BEDROOM BEDROOM 2 OPEN 17"0 x 18"•8" 13' 0' x 15'•8' i - STUDY SECOND FLOOR DINING BOOM 13' 0" r 12'•0" 4828 = .-1344S F 48' Jt� 1 Z(\ NIT DEP Tq.tENI T+ Off HEAT,I KITCHEN SP P �`" APA ' ;V D FOR * cJ; � i �J p Lr (_'0 j 0046' j� ROOM r .:EDROO �;S ' fC N VE LIVING ROOM ' w f FAM1LY ROOM 1 3..0.. x 1 •'.0.. 13' 0" ■ 17' 0•• FOYER l FIRST FLOOR 4829 = 1 .1 a4� F r� To: • r •• M 5°30Z Pfojecl: Gentlemen: We enclose (/ ) copies of: • B/W Prints O Reproducibles O Reports O Tracings • Specifications O Memorandum O Copy of Letter O Description: Revision /Date No. &'C 'lea scowsz'" Sent Via: • Our Messenger �' 0 Blueprinter O First Class Mail O Special Delivery • Your Messenger O Hand Delivery O Copy lo: Very Iruly yours, LAURENT ENGIN ERING ASSOCIATES, P.C. Per: LAU RENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE RWa 22 d Mifttown Road Brewster, New York IOW9 278 -2958 (914)276.8109 . (FAX) CONSULTING SITE ENGINEERS Dale: To: • r •• M 5°30Z Pfojecl: Gentlemen: We enclose (/ ) copies of: • B/W Prints O Reproducibles O Reports O Tracings • Specifications O Memorandum O Copy of Letter O Description: Revision /Date No. &'C 'lea scowsz'" Sent Via: • Our Messenger �' 0 Blueprinter O First Class Mail O Special Delivery • Your Messenger O Hand Delivery O Copy lo: Very Iruly yours, LAURENT ENGIN ERING ASSOCIATES, P.C. Per: PU *1 COUNTY DEPARTMENT OF F LTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of ,:��All. �l40 13JILPEI ?G 1 NG Located at (T)- �"(j�cp�j Section 3 Block Lot 2f Subdivision ofZOX14 ,,, �� Subdv. Lod ;� �� Filed Aiap y X11 Date S- ZZq�f3 Gentlemen: This letter is to .authorize iAA9R f N , NIC,40 E V-::: ..a duly licenseSi professional engineer X or registered architect (Indicate) p 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 promulag--ated- by the Commissioner of the Putnam County Department of Health', and to' sign, al'1 .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.' X I 3�tt' Counte signe P Dg-E , R--� \�FE S1pza Millbrooke Office Centre Address $rewster, NY 10509 914- 278 -6108 Telephone , Very truly urs , I.ue'!I Signed Owner of Property ./ MI. I M WQi,3 WN MORM.►► �i% Telephone Putnam County Department of Health Divisir of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBMITTED} TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for -- .. - -. - -. o represent that -I am an officer or employee of the corporation and am: authorized' to act for_ (name of corporation) having offices at _c2M?_N_Vj\ Uit�T -4 -1 _ �O_.�,_ _ _ ,_ _ Whose officers -are President -' dame and Address) 7 Vice - President _ _ _ ' -' - '(Name and AddressT — • — ^ — L Seere -tary _ _ _ _ _ • _ — — — (Name and Address) — — — — r — — — — Treasurer" — . (Name and Address) and that I= am-and w.11 be individually responsible fon any o all aptp . of.the corporation with respect to the approval re seed d -a 1.sub Sequent aets relating thereto. Sworn: to before me this day Signed of ,l/rh 19q� Title Notary Publi - s OW � I DAMS MwPTi emv,i3&/1721'®F:mv RM, f•4w 2-,3T Corporate Seal i LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 8& Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FA)Q 278 -2658 HARRY W. NICHOLS JR., P.E. On CONSULTING SITE ENGINEERS December 22, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Indivisual SSDS Cornwall Ridge - Lot 46 Somerset Drive Patterson, N.Y. Dear Bill: Enclosed are the following: Four (4) prints of Drawing SS -A "Proposed SSDS - Lot 46 ", dated 12- 15 -95. 2. "Application For Approval of Plans For a Wastewater Disposal System. 3. "Construction Permit for Sewage Disposal System ", dated 12- 22 -95. 4. "Application to Construct a Water Well ", dated 12 -22 -95 "Design Data Sheet ". 6. "Letter of Authorization ", dated 12- 22 -95. 7. "Corporate Affidavit ", dated 3 -6 -95. 8. Two (2) copies of Residence Floor Plan(s), for 'Bedroom Count Only ". 9. Money order in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. H W. Nich is P.E. Jr., HWN:bd 93071 cc: Cornwall Home Builders, Inc. w /enc. - .PUTNAM COUN'T'Y DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES, DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner LAxkfwALL Harr1C -, 7Rb)LDE23' I-NG. Address zS TNi>I ,&ril �AASCE�oR T-_>R)VL - LNbLq IO C� R 6E1�iw I C }i, t T'• � (0 Located at (Street) Sec. z3 Block �_ Lot ?L (indicate nearest cross street) Municipality -T-o w ,-. o Watershed o SOIL PERCOLATION TEST DATA- RE) QED TO BE SUBMITTED WI Date of Pre - Soaking ;, r z j 9 4 Date of Percolation Test(t 111 tz 19 4 HOLE NUMBER CLOQC 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 O 19,Z-2 9 1 8- 9'R0 1 Z e 3 IZ.3 4 -o 21o'os-10.35 30 Z3 ZS Z )S•O Z3 3 4-o z 4 li �� - 11 '41 -�c�• 21 -Z ..... Z4 z i iZ °:o cj II.43 - 1Z�13 3n .. _.20 •�..... .�3 -� - -- .- 3........ .. _ .�o.:O Z 7 Z-3 I 2 3 �2 904- 9 16 1Z Z) i Z4 2- 4.0 2 9 1 8- 9'R0 1 Z Zo Z 3 4 -o 3 9'32 - 5".14 1 Z Zo Z3 3 4-o 2Z Z 7 6 io'24`- l0 3s 4- ) Z6 i 23 z 3 4 7 NOTES: 1. Tests to be repeated at same depth ..until.approximately -equal soil -rates are.obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA SQUIRED TO BE SUBMITTED WITH Al iCATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. Z HOLE NO.-3 G. L. L ;L To ti so l L. L o ►r+.T I o �-5_ T „ u 7`RE b y 6 LC_ OtiJ 1.;--OW N Z SANay ILoAm ►z ��►vc S��v� LoArn lZ t=�tiE S.aI�O Lo�rn 3Z SAnjoy . LOAN► G'TsA�y "(,,j Z.(, 7Bitar Sc�Un Lo�irn )j suo w asam,3m SILT L,* A 48 G 2,%y 'S �iTni n Loam R�Gk vet i-�-H CJ 2A V C-r, t i1 L o AMU ' 7Z' �(Q ' Nyo 20CK Uo ROGK INDICA'T'E LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED )U ONE INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED Ind %A DEEP HOLE OBSERVATIONS MADE BY: M , 0 J1?ZI DATE: a 1 j 9 4. DESIGN Soil Rate Used 8 - )© Min /1" Drop: , - 'S:D. Usable Area Provided �000 No. of Bedrooms 4- Septic Tank Capacity Z'_-57<n gals: Type C,on,c. Absorption Area Provided By 4 4.4 L.F. x 24 "'width trench Other 1' -D" Name HARK, W. )mil, � -x� � T_j� _ P.E. Signature G.O. Address M 1 Ll BRoo10E O ���c� c C� v-� RC SEAL T rZTG_ Z Z Ml Ll. j O W N 1ZOAD THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ;:._` ND.S�; Soil Rate Approved sq.ft %gal. Checked by �� Date _ JP�U'T�i'AN� CO�CJ'N'r�Z" 7J��ARTI�EN'T OIL' H3✓,Pa.X..T� APPLICATION! FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM i . Name and Address of Applicant: 6/�,y -1wclY #bc4,,a l / 2. Name of Project: i� ose�f_ �S 3..,_. � J LocatioftG)V /C: 47� /SbY1 4. Project Engineer: RI'"l�/� /:�6���5 al : 5. Address: Nillbrooke .Office Centr Brewster, NY 10509 License Number: SG% Z` Phone: (914)'278-6-103 6. Type of Project: Private /Residential Food.Service ....Corrnercial , Apartments Institutional Hobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject =to State Environmental-Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt_ Type II. Unlisted. 8. .Is a Draft Environmental Impact Statement (DEIS) required? ........... 9. Has DEIS •been completed and found acceptable by Lead Agency? ........... o Rame of Lead Agency ki1A — 1i. Is this project in an area under the control Of -local planning, zoning, or other officials, ordinances? ............. ,2. If so, have plans been submitted to such *author.i tie s?.,. ................... • i 13;. Has preliminary approval been 'granted by such euthcri�ie's? Date Granted: Type of Sewage Disposal : System Discharge...... Surface Water _Ground Waters; 15. If surface water discharge, what is the stream class designation ?........ _ �� :6i Waters index number (surface) '7. Is project located near a 'public water supply system? ..... s. If yes, nave of water supply kZA Distance to water supply s. Is project site near a public sewage collection or disposal system ?..... //o '0. Name of sewage system Distance, to sewage system .U.el i• Date observed: 23. Name of Health Inspector: V1,F)0_P;i14 1 4. Project_,,,aetign flow (gallons per day) ..................... .............. .-goo 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. A/y 26. Has SPDES Application been submitted to local DEC Office? ............... Z 27. Is any portion of this project located within a designate-d Town or State wetland? ............................................................. 28. wetland ID Number ....... .. ........... ............................... 29. -Is wetland Permit.-required? ........... ...... .......... ... XX_ 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 DESCRIBE: 33. Is there a local master.plan or file with the Town or Village? 34. Are community water, sewer facilities planned to be developed within 15 years? /A% 35. Are any - sewage. disposal areas in excess of 15- slope? ........................ f110 36. Tax: Map ID Number ......................... ............................... . 64:1) ) 37. App'r5ved Plans are' to­be: returned to: .....'........... . Applicant _ Engineer £f the application is signed by a person other than the applicant shown 'in Item.1, the. =Pplication must be-accompanied by-a Letter of Authorization' Failure to comply with this Provision may be grounds for the rejection of ariy submission. I hereby affirm, under penalty of perjury.- that information provided on this form is true to the best of my knowledge and belief. False state,-,d'nts'made herein are punishable as a Class A Hisder,eanor pursuant to Section 210.45 of the Pena 1 Lacy. .1 !I 3IGNIATURES & OFFICIAL TITLES: Millbroo�e Office Centre 'AILING ADDRESS: Brewster, DIY 10509 \ \ \ \ \ \ \ \\ \ \ \ \ \ \ SaLA9, LZ \ \ so EC: $ \i 5 a 53B \ 1 \ 1 w .\ \ \a �S\ Q�2 a1 \ v \ S� 555 �I w .\ \ \a �S\ Q�2 J� v 555 �I � - APPROX- 'EX /ST - � vRADE � 545 160 L.F. ¢0(S-OR- 36) 540 535 530 ff AROF /L E 5: SCALE : !'� .30 '/�/0' /' = S' YE/ 1490 J ` \ \ \ \ \ E o \ \ \ \ 7vsr. K O \ \\ \\ \\ \ \ \ �i \ \\ \\ \ \\ \\ \ \ \J � • 546 \ � \.\ \\ Q \\ \� \ \\ \ \ \ \ \ °, V 481•\ \ \ \ \ \ \ \ 550 \PROP - Wal APPROX. EX /ST. 58 s \ Cho \ \\ 125� 160LE40(5DR 35) \ SoL /O 11 ��\ 0 \ \ m 540 \ \\ u • PROPOSEb \ Wf \\ \ g BEJrPOOM • ^\ FP \ � / �� \\ ' `30'11OR.