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HomeMy WebLinkAbout0562DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -26 BOX 7 I No _. ti VC 1 it 'y, 'kQ J6 r , 00562 1,7 V P UT N Am,cotN,ftDkOAfTM----NtbF.EEAITH vson of Envirannefiini Health Services, -N.Y;-:�1' 0 512,,,- eer not Provide �% A C1 i-4 L��,7 e, i5X,,AVA—r1k1A Addres- Se S'.0r, built y Separate il� system —GaHop Selide Tank and Consisting Of. Water Supply; —Public. Supply From Address "Y or:_ Private Supply Drilled by Addresls -Krri Al -i- Erosion: Wjff�, f r- V: Control Been Completed? Building Type Hag oi Number of Be,,dio*q6 E[,W Garbage .Grindei Bee.. Inst.W? I �certif y' p at the systems) asjisied servinj, . the above pi er , �is*ea;� . werec constr�ucied'esseniiallj'a I a shom on the plans'of the completed work copies of which are attac and in accoidarice iith �thi itanda,rds i"M-de's, re . 9 af.ons-in accordance . with t I file plan the permit issued by the hed). Putnam County Department•Of Health. P.E. Date t; I, iii'6 ZZ - A-^ J4 A dd Licari No. tl� liei h actibri:as may be neceisari,to secure' the correction of any Unsanitary Any,.poisOn octispying,primises served bYi, a v :i'stlern(s) ishall promptly take suc he bo a y t u' the separate ssWiiirjgo-4�stem. shall -b pu z sanitary so'vkw becomes conditions re.s4.1 ing. from such Approval :0 *dome null and viola as saidn'sis 61 - g,. 1313i or w4t§j*,sijO'pIi- boiorh" approvals are available and the approval of the 'rhate water i y iloacpMe nui,�anq �.vqyv.vr an available. Such IU subject to modification or change when; . the 'of thd'-CorMm-"6iIdff*'.1 GO AU0. revocation modification or change As':nscosssry. In Data Titl M , �tw�Ir. ITTf, T P r%xmy TTTl1LT n1 T1nnT j .� W Y WL'LL VVL'll LGllVLtl L\LtL VL�a DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET AOURESS: WNW t TAX GRID IIUMIIR- Somerset Drive, Lot 30, Patterson, New York WELL OWNER NJ �K. VIGILO REALTY CORP,., CarriaADDRESS: l Estates, Brewster, NY PRIVATE O PUBLIC USE OF WELL 1 - primary 2- secondary XMESIDENTIAL O PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS O FARM O TESTIOBSERVATION O OTHER (specify) O INDUSTRIAL O INSTITUTIONAL 0 STAND -BY 0 MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 — 4 / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ®ADDITIONAL SUPPLY OONEW SUPPLY (NEW DWELLING) ® DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 345 ft. STATIC WATER LEVEL 40 ft. DATE MEASURED 1.1/24/92 DRILLING EQUIPMENT O ROTARY X)Q COMPRESSED AIR PERCUSSION 0 DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING (OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH tt: MATERIALS: X®(STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE �� tL JOINTS: 0 WELDED )(THREADED 0 OTHER DIAMETER SEAL:)Q CEMENT GROUT OBENTONITE 0OTHER WEIGHT PER FOOT Iq _ Ib. /ft. DRIVE SHOE] YES ONO I LINER: O YES ONO SCREEN DETAILS DIAMETER (in) SIOT SIZE LENGTH (it) DEPTH TO SCREEN (1t) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK ONO GRAVEL SIZE: DIAMETER TOP OF PACK in. DEPTH 1t. BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping METHOD: O PUMPED tests were done is in- t )D(COMPRESSED AIR r formation attached? O BAILED O OTHER ❑ YES ❑ NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE YYi1Ct gear- ing Well Oi"- meter FORMATION DESCRIPTION poE tt WELLDEPTH It. DURATION hr. min. DRAWOOWN 1t, YIELD gym. Land 2 Soft.soy topsoil. . 2 $ Soft white limestone. 300 2 - 300 8 345 White limestone, 345 6 65 WATER )( CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? )V YES ONO ANALYSIS ATTACHED? YES O NO STORAGE TANK: TYPE tap rogn CAPACITY 7 GAL. 4 PUMP INFORMATION, TYPE subjuslble CAPACITY 10 MAKER GQl11r1S DEPTH 2M MODEL IO J05412 VOLTAGEM HP .1/ L WELL DRILLER NAME or ADDRESS MILL DRILLI Sid N [IL/ 1/ rewN. / Brews 1. J/ 0 1 CHEMICAL PHYSICAL" BIOLOGICAL NAME AND ADDRESS OF PERSON TO RECEIVE REPORT ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 P.O. BOX 2328 203 - 748 -7903 eATER /WA3STEWATER METHODOLOGY APHA - EPA - ASTM REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER Mill Drilling,: Inc. Putnam Ave I Brewster, NY DATA 10509 SOURCE OF SAMPLE Water Supply, J. K. Vigilo Const. Corp. Lot 30 Somerset Drive Patterson, NY DATE OF COLLECTION Nov. 27, 19 9 2 COLLECTED BY Mill Drilling Hydrogenlon Concentration COLOR TURBIDITY ODOR CORROSION INDEX LANGELIER DISSOLVED SOLIDS (P„) RYZNAR NTU Mg /. Nitrite Mg /L Alkalinity as CaCO3 Bicarbonate Mg /L Fluoride (F) Mg /t NITROGEN CONSTITUENTS AS NITROGEN (N) Nitrate Mg /L Alkalinity as CaCO3 Carbonate Mo /L Chlorine Residual .00 Mg /I Ammonia Mg /L Total Hardness Mg /L CaCO3 M /L Conductivity Micromohos /ch Mg/l. Iron as Fe Mg /L Mg /I Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /' Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg/ The arithmetic mean of all standard sample* examined per month using the membrane filter technique shall not exceed MEM1711AnI- rlt.ttrt IrOl one Colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50ml. 4 /100ml, 7/200mi. or 13/500ml Coliform Colonies /100ML in: (a) Two consecutive samples; (b) More than one standard sample when less then 20 are examined per month: or (c) 0 More than five per cent of the samples when 20 or more are examined per month. AT THE TIME tHE SAMPLE WAS SUBMITTED: El1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 3.. This sample was not satisfactory since It did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group in a sample of potable water is undersirable and. while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. 4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which.`indicated the water potable. Certified PUIN M COUNTY DEPARTMEW OF BFALTH DIVISION OF ENViRONNME AL fMLTH SERVICES Building by Aeot L Location — St Building Type c-23 o?e Section Block Lot LIM i Subdivision GUARANTEE OF SUBSURFACE SERE DISPOSAL 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 Dent 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 disposal 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 detez ination of the Director of the Division of Environirental Health Services 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 this 9/dday of 19 1 trac (Owner) - Signature Corporation Name if Co .) Address rev. 9/85 mk Signature Title �ts , Corpora Name (if Corp.) %rig! P ess Qd�s xIS . � txlsT. 5ro Nc - 1,k,,, ftI T. w6u- �, =0R SETTLEMENT FIrrAll HEP G.FApE l N FILL C. FILTER \ ERFORATED PIPE U� EAS \ \ \ / \ \ \ \ ) SLOPE %92 PT. `.j rz CRU5HED 5TONE � \ \ /A5HED 6RAVBL /��P w�u' x \ \\ :TION \ 8 I / / \\ �� \ \\ \ 1 \ \\ \ � \\ is+ \ \ \ \ \ \ + \\ \ \\ \\ \\ D pipe \Pf.-I « 0 . CTYP a2 Y52 FT. GAP ENO \ k d PAL 4 q' ! — OF EACH NT ATERAL s� 1 I/ ; r `� TAN �, S, \ �� zl a r r 1 / 16.q)„ %-A LA �H TRENCH TPRIOR UO WG'I,L r+ , I 'F ALL DISTRIOUTORS WITHIN Zoo I I I I \ \ �/ Y \\ \ \ \ \ I ---'TION TRENCH �� I I\ i V\ 4 p +7) FINISHED GRADE REMOVAOLE 6OVrr- N x \ I \ \ \ I I A y^ zS INLET ; •. '• t�r�r _ �InrGuG� JT • _ _ _ i'ROR WBbL 's OUTFLOW a'..- 9 "70 G" DEEP /+ li4 + MIN. WNG.FOOTINGJ •y SECTION 'A-A' 2X DETAIL. ;sue 3 � t S 3 C _ 5 � r s � s _ `t _ { L L.,�1 y -J- � d ,� li'4 �fi,.. '�.'h` M y } ; ,� x �� •y4 fi i��-j v3 a �4 S. '" � x.y°z, __ :4, ...� - r_ .r � a �'� �- ��� ��J�tN(;��l�i DN� fiNf�E1����C►N �) `�; = � �� J.� � ;sue 3 � t S 3 C _ 5 � r - f 3 { r >z G L 3N r s � s Z Fcc^[C 2 � L L.,�1 y -J- � d ,� li'4 �fi,.. '�.'h` M y } ; ,� x �� •y4 fi i��-j v3 a �4 S. '" � x.y°z, __ :4, ...� -. � s" Jo. _. .� <<.:t -` *; � �.. .. ��•.. 4n ° 4• ri -. .��.erau_.ltl�l'�'�x= ..A,�aa.` v ! P s` I Y yX" F � � x r - f 3 { r >z G L 3N �o11n oar deal �r f�tI18ID epBT �m J I'll / vi iol Environmental Healt f w co ormanoe ;with =pprove as noted: lati`ons.:oY the fi applicable Rules and ,Regu t ;jitnam= :County Heat Departmen. °° 5 - ,��ai5taro s z A 3, d' � z fi �' f✓ 1 q.. 2 « C r r �V Z Fcc^[C 2 � L L.,�1 y -J- � d ,� li'4 �fi,.. '�.'h` M y } ; ,� x �� •y4 fi i��-j v3 a �4 S. '" � x.y°z, __ :4, ...� -. � s" Jo. _. .� <<.:t -` *; � �.. .. ��•.. 4n ° 4• ri -. .��.erau_.ltl�l'�'�x= ..A,�aa.` v ! �o11n oar deal �r f�tI18ID epBT �m J I'll / vi iol Environmental Healt f w co ormanoe ;with =pprove as noted: lati`ons.:oY the fi applicable Rules and ,Regu t ;jitnam= :County Heat Departmen. °° 5 - ,��ai5taro s z A 3, d' � z fi �' f✓ 1 q.. 2 « C r PUTHAM COUM, OFHBAM Cereal. N.Y.1�SU to Pti6W Palai�lt \� , %4 ... Dhltia� sf irv�d i�ae116.Seedeei. a CI3l1IIRCATB OF CO Paslt I Q P®!M FO)R WAf$ Df8lOSAL SYST®1[ Co Wl 7/_ L. 1 f I�nMi N ,r ✓ •��i 1✓ei 1� j"i V i'•.� �Y x ar•{�e`�. /� laiaivllia� N' t-liy n wa ( gat / T. Mat:` �/ d� ' r (/ �% / to Y Feeewal O Yaddee 0 . . O'w /AtPNt t N . Date of Prevba Approval GNa> A"" V y !�l Ya4/ eV TOwgf✓ OF Date Subdivision ADDroved �— Fee Enclosed_ Atnmmnt CD Q os Rev. 10/88 Dliiy 1jT, �h I Lot Am 1 t 9` E", Neior of Hdianea DWO Flow G P D OQ sow«.. Srlo�. a oow.c alt Ua4 TGan sepa Trek saw 3D To ra;ea.ehrtetad by I �. Addi�eoo Wage 5t*p NiYe Ftwt AddteM Sltp Sw* DrWad b-v .� +PZ �. 1 represent`.1hat l am wholly and .co responsible for the design and location of. the proposed system(s): 1) that the separate ones di sal stem above described will M constructed as showh on the approved acme dment there to and in accordance with the standards, rules a rpu ions o na County O,pprtm lt. of 1Nalth, and that On completion.ther of a. "Certificate. of,Constructlon Compliance" satisfactory to the Commissioner of Mealthwill be suOmlttlid to 'the t)e1 a 0*..and, a wratlan guarantee will;Oe furnished the owner, his succe» ors, heirs or,.afsigns by the builder, that, old bulkier will race iA food aspera'tNg tondition,any _part of nid,,fewage 'dkposal. systean during the period of two „(2) years Nnmodlatey follgwlg,th* date of the hew once of the` appraNl of tho' Cortificate of Construction Compipnco of th origin l system or any repairs ttwreto: 2) that the dialled will described above will be located as ” a, %*on the approved plan and that said well will be instal in accordance with the standard ru a rpu ns of the Putnam county Department Of Ffeakth: 0447 �y �j 9 S 'nod P.E R.A. y `/ G-. AOdri O License N � APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the`buildiny has been undertaken and is revocable for cause or maybe amended or modified when eonsilered,naeessary by the Commissioner of Health. Any charge or alteration of construction requires a new permit.. Approved fforr disposal of domestic sanitary. sewage, a '. private water supply only.�//��/ Date ��� ©� // .,1 / /Z- By � Title ��!—� APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DMSION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT 4ME OF OWNER Y z ` C/ STREET LOCATION S ' DATE /­2c, DOCUMENTS. ����N////'' RMIT APPLICATION pc 1 _ WLLPERMIT; PWS LETTER BEERS AUTHORIZATION JN DATA SHEET(DDS) HOLE LOG PERC RESULTS (3) TAX MAP # _ —� — " 4 CHARGE (OK) PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION E EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED PIT & D BOX SHOWN & DETAILED ­13911OUSE - NO. OF BEDROOMS ELLS & SSDS'S W/IN 200 FT. OF PROPOSED SYSTEM �� OPERTY METES &BOUNDS J �C HOLE DEPTH USE SETBACK NECESSARY (TIGHT LOT) RATE RESOLUTION SEWER - 1/47FT. 4 "0; TYPE PIPE PLANS THREE SETS -m-NO BENDS; MAX. BENDS 45 W /CLEANOUT HO SE PLANS -TWO SETS ARIANCE REQUEST GENERAL _ AL SUBDIVISION APPROVAL CHECKED �RC RATE FILL REQUIRED 31GURTAIN DRAIN REQUIRED mSTA'N'DPIPE 9-EX--APPROVAL SSDS ADJ. LOTS WETLAND (TOWN/DEC PERMIT R & D) -9-'DATA ON DDS PLANS & PERMIT SAME 1969 - NEIGHBOR NOTIT'MCATION°'''`� R B1/ZBA f/C� � 00 YR. FLOOD ELEVATION AGE SYSTEM PLAN - FILL SYSTEMS m 10 FT HORIZO AL: SLOPE 3:1 TO GRADE m FILL SPECS mDEPTH G GES m FILL PR FILE & DIMENSIONS ED VOL ,�� TRENCH M� LFTRENCHPROVIDED 3� 2 rnEEI60 MAX ��PA%RALL EL TO CONTOURS 1t70°r6 EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN .L., DRIVEWAY, LARGE TREES, TOP OF FILL :)UNDATION WALLS HYDRAULIC PROFILE ---1=dJL7 GRAVITY FLOW °x`10 OWELL, 200' IN D.L.O.D., 150' PITS OX 10-r; EN n-Au EY�H-P= PPiDETAII:s- 100 -STREAM WATERCOURSE LAKE (INC.EXPAN) C TANK - SIZE, DETAIL ' ATCH BASIN, 35' STORi DRAIN, PIPED WATER DETAIL, SERVICE LINE IF OVER ATER LINE (PITS -20') TRUCTION NOTES (GRINDER RATE) RMITTENT DRAINAGE COURSE :N DATA: PERC AND DEEP RESULTS 200 . RE m 150 FT. GALLEY SYSTEMS FOOT CONTOURS EXISTING & PROPOSED SEPTI T :WAY &SLOPES CUT `FROM F TO WELL NG /GUTTER/CURTAIN DRAINS WELLS )MMENTS : WELL TO P J - -U11Ly 11C(Jc1VL111'_'11L OT tjea.irn Division of Environmental Sanitation AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBM?TTED• TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for I• ._ - F _lL'_ LIZ, 1�_ %J1�----- ._.,. -- - - -- - pepresent that .I am an officer or employee of the corporation and am_ authorized' to act for _ _ 7� /� _ VilG _�O_ J �F& �,_ _ (name of corporation) `- having offices at Whose officers -are President _ _ T4z.,Y (Name a _�ini(> — )..��;/.�� cT Tddress _. Vice - President -'(Name and Address) `� L Secretary � /U ' �� _ (Name and Address! % ... — ... ... ) . L Treasurer' • (Name and Addr ess) — • - r and that I=am-and will be individually responsible fon any'or all aptg . of the- corporation with respect to the approval requestgd and•all.sub- eequeit acts relating -thereto. _ Sworn to 'before me this , -day Signed An o uja j j4 199 Title Notary Publi - BONNIE J. DAVIS ••ne:.'rtrarac, WAUo9xWV= REG.94985306. • . 'AL19ED IN DUrCHW I0tX! M MSSION EXP B AUCL IZ Corpor4te Seal Ott . 1� c. PUTNAM COUNTY D E PARTMENT O F H EAL TH AUG 12 RECD APPLICATION FOR APPROVAL —O7F— PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: -er 2. Name of Project: ��G,�eS �.� ��� 3.._ Location'V /C: 1a�4. Project Engineer: vY bu ry 5. Address: %3 ���►\y/ �- � r� y � License Number: Phone 10ej' 6. Type of P o ect: _: :.. =,- Food -Serarice .... Commercial , Apartments Institutional Mobile Home Park Office Building Realty- Subdivision Other (specify) 7. Is this project subject to State Environmental•Guality Rev ew (SEGR)? Type 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? ........... 10. Name of Lead Agency /V 11. Is this project in an -area under the control of -local planning, zoning,- - -- orother officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. �- 13. Has preliminary approval been - granted by such authorities?� T Date Granted: 14. Type of Sewage Disposal_ System.Discharge...... V Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ J 16. Waters index number (surface) ........... ............................... _ 17. Is project located near a public water supply system? .................. A/C, 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... /VD 20. Name of sewage system /V/ Distance to sewage system 21. Date observed: Le & _ 23. Name of Health Inspector: /2, =4. Project design flow (gallons per day) ...... ............................... aa y . 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 0 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? .................................. ............................... 28. Wetland ID Number ....................................................... 1v 29. -Is Wetland Permit- required ?•o.. ................. ......................... Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... /mod 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous Waste disposal, landfilling,'sludge application or industrial activity? ........ YES or NO / "d ;.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 lye 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? v" Lot, ��. 35. Are any sewage disposal areas in excess of 15% slope? .......... .............. 36. Tax Map ID Number ......................... ............................... 2-3. 37. Approved Plans are to be returned to: ................ Applicant ��Engineer .If the application is signed by a person other than the applicant shown in Item.1, the application must be accompanied by�a Letter of Authorization: Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: �vSo ,_ Al PU NAM C7JUNI'Y DEPARTMENT OF BEALTH DIVISION OF ENVULtZE= HEALTH SEWICIS AUG 12 RECD DESIGN DATA S'd=- SUBSiJFAC.E SEWAGE DISPOSAL SYSTEM FILE NO. Owner �C �%� I t,v �v2 Address _ GTfZfZ��4 C7� I-{ (U�2�6"��✓ Located at (Street)TPE50NT POA P Sec. Block Lot Z�v (indicate nearest cross street) Municipality jT"�A' 00 �1. �(. Watershed 4,'LZ±T,9 ,J Date of Pre- Soaking Art Date of Percolation Test to /Pj�j HOLE NL14BM CSC 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 4 5 1 2 3 4 5 2 2:A8 3 4 5 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 sukmittbd for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA RDQUZ.RED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO_ HOLE NO. G.L. .2' 3' 4' A 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LE•4EL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .DEEP HOLE OBSERVATIONS MADE BY: hG�T I?�UD�,��1sK�' DATE: 1p DESIGN Soil Rate Used _Ib Min/1" Drop: S.D. Usable Area Provided 5,9D S. No. of Bedrooms Septic Tank Capacity 1,90O gals. Type Absorption Area Provided By - �} L.F. x 24" width trench Other g1� Name �� . NIGFiOih _�[�T�� . Signature. . a Address ��j_I'P I U� SEAL w ot`1 N . 12 ��ymF No.561ia A O� THIS SPACE FOR USE BY 'HEALTH DEPARM NT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 August 6, 2002 Ivon & Patty Palacios 16 Somerset Dr. Patterson, NY 12563 Re: Addition - Palacios, 16 Somerset Dr. No Increases in Number of Bedrooms (T)Patterson, TM #23 -1 -26 Dear Mr. & Mrs. Palacios: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated August 5, 2002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this department. 2. The SSTS must be expanded as shown on plans approved by this department August 5, 2002, R- 253 -02. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson.. If you have any questions, please contact me at your convenience. Very truly your ..---- William Hedges. WH:lm Senior Public Health Sanitarian cc: BI . u ` -.d BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014, Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION MESIDENTIAL ONLY) STREET IW-- TOWN A TX MAP# NAM>Q U6 VAL�0, ONE . 0.70 -- -'571 S PCHD# MAILING ADDRESS DESCRIPTION OF ADDITION VL/ . 10!5 l'2 NUMBER OF EXCSTING BEDROOMS -J PROPOSED # OF BEDROOMS_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION PROM BUILDING. INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00.. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 4) *Non- professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Whouseguidelines ti SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY TM# v� 3 PHONE 045' ygrops'. PERSON INTERVIEWED PCHD Complaint # ame & Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER1 K- 11 PHONE 1960 � ® ADDRESS q0 � M A GISTRATION# Pro osa (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. I, as owner, ore rt ge wner agree to the conditions stated on this form. SIGNATURE TITLE DATE 1. Procurement 6f any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title AATEt/ COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 991E i r . aiwriisnaa3r� oiwgoaosl � ."RIM ii�ry�ieiic,iiiTr_ 1 wig i Wgw'�LLy was SCl1IL,a.rlrl�.rr,�f' nw r{:w1/�«L1011A • iiieGaiiil3, �. ■ :ot t•�I�Itir q���l� ar � _ -_ __ -�i' ➢�� � • rig r Isg.�.awgr,JE� a are +ir• rzeu i. �rd��i`ru�on• Cs :o Zia y BP{�'iiii� id f ll «:jii-wrl tm _ � 9 1 � �3y oa H l ell- Putnam Cmmty'p i of HeaHh Wit► d Envbonnwrdd Health service i ,zaro. ! +as troted for m-4,mm tee wlth �of the Ruliot old yr .� i SIX 02 Io ID A"- Tt -aIC44 C-rrP) 3 a c f %Li �� ✓ita-0—c- 107 f _ fJ ��� j8 "HI �•� . �0Ott orM�I��IOI.t GNt�izTCIN fttnam county D p,-twni 03 He�I3 lieta� of Environmental Realt CJ� f�� fnF aS ormanae .vith I Tttit c�r'uN TAx MAP' : '94-1 V& PROJECT- PROPOSED SSDS *eol °N (wa ov�NwAU �IV�,� LDT.4+3o 1'a-rT� °N NY CLIENT 7 iG vi III L O �e-a L,TY a012 fiR (�1I«gC H IW ,�.Jf: LAURENT ENGINEERING ASSOCIATES, PC. 73' FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 (914) 278.-6106 CONSULTING SITE ENGINEERS DRAWING TITLE AS-BUILT. PLAN SCALE Ius�jQl 6O v `I4 DATE - a sa 3q 9 1Q�i qZ 8. B.R.e X58 q b7 5 52 to �e.5 ati 11 1245 bi ' 12 Y!/f:5 '15 hi 132.5 'f2 15 MD G2 fttnam county D p,-twni 03 He�I3 lieta� of Environmental Realt CJ� f�� fnF aS ormanae .vith I Tttit c�r'uN TAx MAP' : '94-1 V& PROJECT- PROPOSED SSDS *eol °N (wa ov�NwAU �IV�,� LDT.4+3o 1'a-rT� °N NY CLIENT 7 iG vi III L O �e-a L,TY a012 fiR (�1I«gC H IW ,�.Jf: LAURENT ENGINEERING ASSOCIATES, PC. 73' FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 (914) 278.-6106 CONSULTING SITE ENGINEERS DRAWING TITLE AS-BUILT. PLAN SCALE Ius�jQl 6O v `I4 DATE - CERTIFIED TO: IN ACCORDANCE WITH THE EXISTING CODE OF PRAC- TICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOC. OF PROFESSIONAL LAND SURVEYORS. LOT 30 AREA = /. 436 AC. 31 Unquthorizeda/terotion or adq'ifion to o survey map beorin9 a licensed /and surveyor's seo /is o vioioh6n of Section 7209, sub - division 2, of The New York State Education Low. Certifications shall run only to those individuals and institutions shown hereon under the title policy No, shown above. Said certi- fications are not transferable SURVEYED & PREPARED BY BUNNEY ASSOCIATES LAND SURVEYORS RURAL ROUTE #2 FIELDS LANE NORTH SA EM. NEW YORK 10360 N. Y. 5. IC. No. 49332 Prem45es shown hereon being Lot 30 os shown on "Sheet / of Subd/v/sion Mop of Sec fi on Two - Cornwo // Ridge'; said map filed in the Putnam County Clerk's Office on May 23, 1986 as Mop No. 2/ / 7A . The /ocotion of underground improvements or encroochments, ifany exist, ore not ti cerfied. Prepared For• cJ & .K Vigi /o Realty Corp. SURVEYED AS IN POSSESSION C� SURVEY OF PROPERTY SITUATE /N THE TOWN OF PAT TERSC PUTNAM COUNTY NEW YORK SCALE: I"=40' DATE.- SEPT. /4, Brought to Date: Sept 7, FILE No.. T PS