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Home My WebLink About0563DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -27 BOX 7 r , r �i No' 6 ,. ' , 00563 ` of pUI9,iM COUNTY DEPARTtrME U OF BEAMH DIVISION OF ENViRO -7TAL HEALTH SERVICES Owner or Purchaser of Building Section 54.�% Building Con�jstructed by Location - Street P`Z TFWacipa_lDity _ 1 Building Type / Z7 Block Lot COP--Vkj'j GG XL-del Subdivision Name Subdivision Lot 7 GUAR2.M'EE OF SUBSURFACE S0 .GE DISPOSAL SYSTFM 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 sham 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 "Cert''ificate 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.willfiil or negligent act of the occupant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environiiiantal 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 jLe_ day of "i_ 19 q-1 General Contractor (Owner) - Signature /,s C��( `7 f 7ration Name af Corp.) /a512 rev. 9/85 ink Ba�k�ioc sr ��•ce Corporation Name (if Corp.) Addr TS / rjoLt LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 - 8108 - (FAX) 278 -2858 HARRY W. NICHOLS JR., P.E. In CONSULTING SITE ENGINEERS August 19, 1994 Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 ATT: Mr. William Hedges RE: Individual SSDS Cornwall Ridge Subdivision - Lot #29 Somerset Drive .. Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing S -29 "As -Built Plan ", dated 8- 16 -94. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 8- 18 -94. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 8- 16 -94. 4. Well Completion and Well Log Report, dated 8- 15 -94. 5. Water Analysis Report, dated 8- 11 -94. 6. Check in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:bd 93012 enc. cc: Mr. B. Troll w /1'copy ea. ' YML ENVlHONMENTAL SERVICES ^ 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H~ Padovani, Director LAB #: 33.400173 CLIENT #: 114 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~°~~~~~ TORLISH & SONS BOX 271 ATTENTION; DWAYNE TORLISH ARMONK, NY 10504 NON STAT PROC ~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: DATE/TIME REC'D: REPORT DATE: PHONE: (914)-27i PAGE ? ~~~~~p~~~~~~~~^ 08/08/94 15:3{ 08/09/94 09:1{ 08/11/94 —3448 SAMPLING SITE: CORNWALL HILL ESTATES OUT. TAP SAMPLE TYPE..: POTABLE : PATTERSON, NY PRESERVATIVES: NONE COL'D BY: D. TORLISH TEMPERATURE..: { 4C NOTES...: BRUCE TROLL COLlFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL — RANGE 08/11/94 MF T. C0-IFORM ABSENT /100 ML ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI��_Z1��HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. 6�- 41� SUBMITTED BY:______________________________ Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 x, +0 n. WL.LL UUr1rLL11UN rUXUAI DEPARTMENT OF HEALTH Division Of Environmental Health Services m u PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADURESS. _MWN1ViLLAGLjCIIY TAX GRID NUMBER: a I 10(� �.)� l r WELL OWNER NAM _ ADDAI s: j / .e_e ie ,qL lam- ❑ PBIVATE ❑ PUBLIC USE OF WELL q 1 - primar secondary ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS - O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING .]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY EW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC WATER LEVEL C:9 / Tft6ATE MEASURED14�1d_ljjj� DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH ft- MATERIALS: %"MSTEEL O PLASTIC O OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED )3THREADED ❑ OTHER DETAILS DIAMETER in. SEAL:5CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT lb./ft. I DRIVE SHOE: N- ONO LINER:0YES ❑ NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (It) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP OEPTH ft. BOTTOM DEPTH K. WELL YIELD TEST If detailed pumping METHOD: O PUMPED tests were done is in- "eNCOMPRESSED AIR ,'. ormation attached? ❑ BAILED O OTHER :OYES ❑ NO V�I'�LL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Oia- meter FORMATION DESCRIPTION cat ft tt WELL DEPTH it. DURATION hr. min. DRAWOOWN It. YIELD gpm. Land ,, l: rr � WATER `t9KLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? *IMES ONO ANALYSIS ATTACHED ?'*.YES ONO STORAGE TANK: TYPE�►`�r`Q�.y°l Q� CAPACITY Wes. GAI,._�'Y PUMP INF RMATION APACITY r MAKER �� S ' C DEPTH MODEL VOLTAG?�3 HP° NE SE DAI \C IIIAME J C Ai0 B pTYPE A SIGN RE ! .3/ by 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 Address Town Village City Tax Grid Number s/ WELL OWNER Name Mailing Address ®Private:; D c�., 1 O Public SE OF WELL 9 RESIDENTIAL ® PUBLIC SUPPLY O AIR /CO D /HEAT PUMP ❑ ABANDONED : 7 6 - primary ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 2 - secondary ® INDUSTRIAL M INSTITUTIONAL O STAND -BY O.. AMOUNT OF USE YIELD SOUGHT tZ _gpm /# PEOPLE SERVED Aj /EST. OF DAILY °USAGE gal REASON FOR O REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 11 ADDITIONAL SUPPLY DRILLING NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED' REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ODUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES , NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot WATER WELL CONTRACTOR: Name : � Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __k--'NO NAME OF PUBLIC WATER SUPPLY: A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: / LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED '3 � - ON SEPARATE SHEET -� 3 (date) & aignature 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 -y (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 asr;ure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration 19 7 Permit Issuing Off icial"--- Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PC -1 P UT NAM C OUNTY D E PARTMEN T O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. Name 'of Project: P°�__17> 4. Project Engineer: lj��_ a 7. License Number: J'5E ( Phone: 3. Location /C:D 5. Address: r mle�lr� Type of Project: _L Private /Residential Food - Service .Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify), Is this project subject -to State Environmental Quality R view (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. W2 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 13 JA 10. Name of Lead Agency 11. Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been..submitted to such.. author. sties ?..................... t,)F 13. Has preliminary approval been granted by such authorities ?_� Date Granted: 14. Type of Sewage Disposal System - Discharge...... Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ i6. Waters index number (surface) ........... ............................... J. Is project located near a public water supply system? .................. 8. If yes, name of water supply Distance to water supply 9. Is project site near a public sewage collection or disposal system ?..... .0. Name of sewage system Distance to sewage system .- :1. Date observed: 0o 23. Name of Health Inspector: tAIL-. Utl1��IlJ�°� i —T 4. Project design flow (gallons per day) ...... ............................... bee D 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 110 26. Has SPDES Application been submitted to local DEC Office? 11_ 27. Is any portion of this project located within a designated Town or State wetland? ................. ........................ ........ ................. iJo. 28. Wetland ID Number ........................ ............................... _ 29. Is Wetland Permit., required? ....................................... ;...... iJ v Has" application been made to Town or Local DEC Office ?... .. ................ 30. Does project require a DEC Stream Disturbance Permit? ................... �1c� 31. Is or was project site used for agricultural activity involving application of pesticide$_ to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO d`1a 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 �1r� 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? UM d 35. Are any sewage disposal areas in excess of 15% slope? ........................ 119 36. Tax Map ID Number ......................... ............................... .�2.�j" 2 i 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 ,!malty 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 Hisdemeanor pursuant to Section 210.45 of the Pena T Law. 31GNATURES & OFFICIAL TITLES: {AILING ADDRESS: �, PUTNAM OOUNI Y DEPARnMqT OF HEALTH DIVISION OF EWIPZMM7AL HEALTH SERVICES DESIGN DATA S'dE:ET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��ZLI C Ir,Lp_ mAddress r G� m Located at (Street) IVY- Sec. 2 Block I Lot �L`� (indica- nearest cross.street) —T Municipality 12c��N .`�_ Watershed "-- mL -Te5m SOIL, PERCOLATION TEST DATA REQUIRED TO BE SUErII'ITED WITH APPLICATICNS Date of Pre- Soaking 6 Date of Percolation Test l % P15, HOLE Kbff R CLOCK TIME P tCOLATION PERCOLATION 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 5 1 2 3 4 „. 5 NOTES: 1.* -Tests to be repeatea at same depth until approximately equal. soil rates are "obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurenents to be made frtrn top of hole. rev. 9/85. 2 z 1 �p1 4 5 _. 3 11 �Z- 2� /z� L•,.* 1 _� 1. 4 5 1 2 3 4 „. 5 NOTES: 1.* -Tests to be repeatea at same depth until approximately equal. soil rates are "obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurenents to be made frtrn top of hole. rev. 9/85. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. 2 HOLE NO. G.L. 1' 2' 3' 4' 5' . r! &u 6' 7' 8' 9' I ti 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROG IS. ENCOUNTERED INDICATE LLB TO WHICa WATER LEVEL RISES AFM BEING ENCOUNTER-ED N/A DEEP HOLE OBSERVATIONS MADE BY: DATE:. le DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided; No. of Bedrooms �' Septic Tank Capacity gals. Type G�nJG Absorption Area Provided By _J , ,r L.F. x 24" width trench Other Name f(A�n� 14 . W I LKO � ? Signature � Address �z- C� 1� SEAL � A1. I i- � /E No. 56124 THIS SPACE FOR USE BY 'HEALTH DEPARTMENT ONLY: RoFESS�� Soil Rate Approved sq.ft /gal. Checked by Date — I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /u vk Re: Property of Located at�j"r Section Block Lot Subdivision of Lam% WA-LA_, Subdv. Lot Filed Map # «%Gt Date Gentlemen: This letter is to authorize{��Y 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 Counter P.E., I.A., i 1 V Ad1drd s s Very truly yours, SigneduG OwAer of Property Address To Telephone lephone -� Ckzt- _ 10 f e=- - -U. Lam_ C- c--; it �=_c:, _ r-12 LCD- SY C, : c 4. —, _-% °-= = ==' -= LL� =c' _ c F == hc:_ _ .Cv_' SCC.n-EE vian L_ t.— F=-U—, V CR �=. DIES— C-r. • b. F= _�ic:� - Dom;.. c= rc� ra Ic. 0 f_-c: tank s: =_ — I ,ace 4_` I I I C_ `%- cQ� Lc' =r C._ _CL•� 1 o _= cf Yc ( 1 C-1 Ckzt- _ 10 f e=- - -U. Lam_ C- c--; it �=_c:, _ r-12 LCD- SY C, : c 4. —, _-% °-= = ==' -= LL� =c' _ c F == hc:_ _ .Cv_' SCC.n-EE vian L_ t.— �B I s OI O O O O O�N I I s � ..fig � ...r 52� O 15 p0 \l� V O 0 I W s O O O Go N I I ion � � `lflililfi x _ r' won AC I Ov Oil AI fW r MQ 0, 411111 A.0 WOW A. Ink AMI AN a lo3.2 118 S E r l Ac �t i z e r R» F- N;�Y � 4 has; UlIBID� -Ot1I1 QA x iecn of Environm� h improved as noted foi ':�pplGable , Rubes and' r 'utnam Count ` health ME .lRnq�'e de Tit�A Fh -W M y �.a't