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Home My WebLink About0577DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -41 BOX 7 00577 �. Al 00577 R d. / 86 . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 j .- Engineer Must Provide 7, `' — 'O r P.C.H.D. Permit q -- RTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM rt pplicant Name ddress ZIP Separate.Sewerage System built by Address Y / Consisting of 2 Gallon Septic Tank and •'V Town dr V e Tax Map 23 ' Block I of Subdivision Name % ; �W, Lot N % Date Permit issued Z� Water Supplyt Public Supply From Address or: Private Supply Drilled by Address f Building Type Has Erosion Control Been Completed? /�� Number of Bedrooms Has Garbage Grinder Been Installed? 'A lo o Other Requirements I.certify that the system(s) as listed serving the above premises were constru ted essentially as shown on a pans of the completed work.( copies of which. are attached), and in accordance with the standards, rules and regu ions, in ac ordan with t it p n, and the permit issued by the Putnam County Department Off Health. Date y � 1 CertTfiey P.E. v R.A.- l . l _ Address License Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the coii ialoti of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a publ,; sanitary sewer becomes available and the approval of the private water supply shall become null and void when a lic water supply becomes available. 'Such approvals are subject to odification or change when, in the judgment of the C`ommm�issio h rev' ;-modification or change Is neca y. Date By T it it r n ME RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. July 26, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: As -Built SSDS Lot #15 Somerset Place Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing S -1 "As -Built Plan ", dated 7- 25 -95. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 7- 26 -95. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 7- 26 -95. 4. Well Completion and Well Log Report, dated 6- 14 -95. 5. Water Analysis Report, dated 7- 21 -95. 6. Money order 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 92096 encs. cc: Ms. C. Pozzuto w/1 copy each 4' wL'LL uvmrLziivv rzrvni * DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TOWNIVILLAGIM I T TAX GRID NUMBER: Ja G 3 _ WELL OWNER NAME: ADDRESS. PRIVATE O PUBLIC USE OF WELL 1 - primary 2 - secondary Id RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE 06 gal. REASON FOR DRILLING REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY ENEW SUPPLY (NEW DWELLING) (]DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATIC WATER LEVEL ft. I DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY VCOMPI SED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE. ❑ SCREENED ❑ OPEN END CASING (9/OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH_, fit MATERIALS: EVSTEEL PLASTIC O OTHER LENGTH BELOW GRADE it, JOINTS: O WELDED WTHREADED O OTHER DIAMETER in. SEAL :. O CEMENT GROUT O BEN70NITE OTHER WEIGHT PER FOOT lb./It. I DRIVE SHOE Iff. YES ONO LINER: OYES NO SCREEN DETAILS FIRST SECO DIAMETE SL07 SIZE LENG (It) TO SCREEN (It) DEVELOPED? XI_E�13 NO UR GRAVEL PACK ❑ NO GRAVEL SIZE: DIAMETER OF PACK in TOP. DEPTH ft. wro DEPTH It. WELL YIELD TEST It detailed pumping M 00: ❑ PUMPED tests were done is in- COMPRESSED AIR , ! ormation' attached? ❑ BAILED ❑OTHER ❑YES ONO 'WELL LOG it more detailed. formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water 8e�r• inn well Dia- mete( FONTAATtON DESCRIPTION CODE fit. IL WELL DEPTH It. DURATION hr, min. DRAWOOWN It. YIELD firm. Land 9 6 WATER CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFO MATION TYPE Aiern MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME DATE ART M. HYATT & SONS, INC. % Well Drilling SIGNATUREJ� Rte. 311 R. R. 2 Box 171� 3 /by u0mmmmag owo TYPE: LAB ID NUMBER: LABORATORY REPORT PW 95 -3852 CLIENT: Carmelina Pozzuto RD 1, Box 282, Ferris Rd Red Hook NY 12571 SAMPLING LOCATION: Basement Utility Sink: 15 Somerset Dr, Patterson NY COLLECTED BY: C. Pozzuto DATE COLLECTED: 07/18/95 TIME COLLECTED: 12:30 PM DATE RECEIVED: 07 /18/95 DATE OF REPORT: 07/21/95 ANALYTE RESULT UNITS METHOD ANALYZED Total Coliform Absent Colilert 07/18/95 E. Coli Absent Colilert 07/18/95 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ACCEPTABLE. NOT ACCEPTABLE. z.a Laboratory Director NYSDOH ELAP #11218 CT Lab Approval #PH -0171 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914 - 278 -7600 / Fax 914 -297 -0536 PUI'NAM COU9fY DEPARTMENT OF HEALTH DIVISIOiy OF ENVIROiZ=AL HEALTH SERVICES Owner or Purchaser of Building QS PREY CoAus7RVC,-riQtQ COMP Building Co structed by L-0t J:�- I s �vne r'Se Y` i U& Location - Street PA ire1ZSe)XI Municipality ,QES r [bt &M,qL Building Type Section Block Lot C 0RNW4L -L -.9 )MO Subdivision Name 15 Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE 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 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 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 determination of the Director of the Division of Environinental 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 f the building utilizing the system. /I Dated this day of �Qu,,m e, 19% Signature Title General Contractor MwnEo - Signature Corporation Name (if Corp.) G . M-1- ` `► / i i � ILLa rev. 9/85 mk Corporation Name (if Corp.) /o� i 4 qtr. N siibmltteo -to ter Depoftmant ano a`writtgn, guarantee will Oe fumifhetl tha own®v his tlitoafsors, talrsor as 4n$ by 1:0 builds► that'tifd buihier will plece. Nt 66im opwatme coiulNlon any earl Of a ffwvaye dispotpl syetoni; durifp the pevklo of two 2j yews ilnerieoiatoly following the date of,the tau- awoo <of ter apprarat oP `the.C4Gtlfkat®; of Conft udlori iComplionea oP tho:oviginal systom'or' any repeiis theFeto :2) that the.dii1100 will "ooforl0eo above Will be lorated:as shorwt on 'this" approved plpn ano that fold well w'ill, po>Installad';, acco►0onca with the ftbnoa 0. :runts and rpu a1i on�i ter Putnam County Oepa"" o1'.Ifealtli Date q ` P.E. R.A. VA AAdreff 1 r ex', av License No APPROVEO FOR CONSTRUCTION: This approval expires tiro yeen "from the "date issued unless construction of building has been undertaken and is revocable for.'cause or: i uy N-&— 4i � %o► wWWified when'eonfider®d,yneCe80ry by thl `ComrPHWonei of. FOOdtIt11. ,Any cMe�ge or. alteration of construction D,., reeuires� permit:. Approved for disposal of'domaitic w6iittaiy tewrag nd or' privat wat®r supply, only. Rev. �.. f-. _ �"'�i Title 10/88 Date f,�C�� ®� 0 s, If 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 # / -9� WELL LOCATION Street Add ess, t To Village City Tax Grid Number WELL OWNER Name Mailing Address OPrivate 0 Public 0 SE OF WELL - primary 2- secondary ��, RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 FARM U INSTITUTIONAL ❑ AIR /COND /HEAT PUMP 0 ABANDONED 0 TEST /OBSERVATION 0 OTHER (specify, 0 STAND -BY G AMOUNT OF USE YIELD SOUGHT S' gpm /# PEOPLE SERVED Ce /EST. OF DAILY USAGE_ ° o gal 13 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION GIADDITIONAL SUPPLY EW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE t�BRILLED DRIVEN DUG O GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _° NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: a -c'-K ti rz Lot No. l WATER WELL CONTRACTOR: Name f�j �) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 2�,_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /V/A LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) (si ature) 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 such a manner as not to degrade or otherwis_e_,- contaminate surface or groundwater. Date of Issue:�� % 19 —- -�� Date of Expiration 19� _ Permit Issuing 0 ficial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller IN _ ' < o BEDROOM .t •�J� 12' -0" .�•, DRESSING- BEDROOM 3. .WALK' 13' -0" x 10' -0 '• - IN CLOSET tr MASTER BEDROOM �J 1'�BRe o o�o►.� � rl Trl ?fv 0 OPEN 17'-0 STUDY �® 4828 = .-1344S F i 48 _ 'rr ../!•nil . r• - � � , •l cj(• '.......: �.-�• KITCHEN Ku • r'(ml M w I r DINING ROOM p I� r MORNING HOOM M 1 13' 0" x 12..0.. �- IL it ._ _• .. _. OPEN ABOVE LIVING ROOM w .m r FAMILY ROOM 13.•0•• � 1!'•O" FOY(ER _ � CI n(%T re n n n 13' 0" a 17' 0.. A000 - 47AAr%r a 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. ffA CONSULTING SITE ENGINEERS December 29, 1992 Mr. William Hedges Putnam County Health Department Route 312, Geneva Road Brewster, NY 10509 Re: Individual SSDS Lot #15 Cornwall Ridge Somerset Drive Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS - Lot #15 ", dated 12- 23 -92. 2. "Application For Approval of Plans For A Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 12- 29 -92. 4. "Application to Construct a Water Well ", dated 12- 29 -92. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 12- 29 -92. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. 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. Harry W. Nichols, Jr., P.E. HWN:bd 92096 enc. cc: Ms. C. Pozzuto w /enc. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date (2 -2-2 92- Re : Property of /at,. � ,. ,,,, ��1� (�!o ZZ_ CJ C) Located at Sor•,_,- �►t,rril�vL -ei (T) Section Z3 Block Lot Subdivision of CDI-L-x c„w /� Lje...P _ Subdv. Lot # l5 Filed Map #_2-./ 1-] 4 Date Gentlemen: This letter is to authorize Nav,,--) 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. Count P.E., ?3 hl «T Address - Telephone Very truly yours, Signed � AYZ4_� Owner of Property Address Town __�lZ- T�2-- (,6�3 Telephone P UTNAM COUNTY D E PARTMENT 4__>3F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: /Ur, Cq rC_ le__, i L, _,C-1 A0;2_,7 U �3 ►-� , Al 2. Name of Project: / 3.._, Location /C: / X act e,acf{ 4.. Project Engineer: yv (., 0 5. Address: '73� �r `�t�l�� / ✓v, i N b SC�I Z4 Lcl° / y RP 7. L cense um er. Phone:�i— Type of Pro ect• Private /Residential. Food.Service ....Commercial > Apartments Institutional Mobile Home Park Office Building .Realty Subdivision Other (specify) . 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? ........... 10. Name of Lead Agency 2 IA 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 .1., .................. ,We I,- 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) ........... ............................... ,7. 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 ?..... Ale ',0. Name of sewage system /U /.4 Distance to sewage system 1. Date observed: (e P, — 23. Name of Health Inspector: .4. Project design flow (gallons per day) ..... (6 dv ........................... m 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?..�`U 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 ....................................................... 4L 29. Is Wetland Permit -required ?'•............................................. .Iv 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 of 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;00O` 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? r1 35. Are any sewage disposal areas in excess of 15% slope? 36. Tax Map ID Number ......................................................... 31 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 Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: TAILING ADDRESS: • VA 1610 C6"%N • we 214WA NOVO Y• a mmm-ml• •1� DESIGN DATA SHEET- SUSSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner At 't 4,-!� / O iZL �Cl eSS Ile-( ✓ X Located at (Street). L� SO �'t �iL S 't/ �/� J V -4 -- Sec • 2- 31 Block _� Lot (indicate nearest cross street) Municipality Watershed Watershed CHC'rc Date of Pre- Soaking Pi S- Date of Percolation Test CG5 HOLE NUMBER CI= 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 p7- t 1 1 2 3 1 ZS-0 7 2,-2- Z� N 3 2 l z' �-� z; s- 5 2- 2S 3 F .3 3 12-: t 3 4 v T -� 2 2-2, 2- 3 12-'( 2s 3 2— ` 4 5 1 2 3 4 r *. 5 R=S: 1. 'Tests -to be`repeated'at same depth until apprmimately equal 'soil rates are. obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS IN TEST HOLES DEPTH HOLE NO. j G.L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' HOLE NO. HOLE NO. INDIME LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICkTE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE:. ( y5 DESIGN Soil Rate Used Cam_ Min/l" Drop: S.D. Usable Area Provided t; No. of Bedroans 6/ Septic Tank Capacity gals. Type Absorption Area Provided By -fOD' L.F. x 24" width trench Other Nam /�Grv,r�., '�! ��. �� Signature • cc Address % 3 ��1,.�� Cc� �-�� SEAL ti " Ou CO,� No: 56124 THIS SPACE FOR USE BY 'HEALTH DEPARMERJT ONLY:;' Soil Rate Approved sq.ft /ga.1., Checked by' Date I DLle EAST \o 0 �o o� Qi i 305. 49'.. I l 1 176.0 /70.0 IZ 180.5 /75.0 13 1660 181.5 14 190 0 167 5 l5 44S 58.0 A5 - BU /L T /N �) A //+45NSIOIV C N' A A B B 42.5 3 37 5 Z / /36.5 1 144.0 3 1 1450 1 150.5 4 1 149.0 1 155.5 5 1 1545 / /6/. 5 6 1 159.5 1 1670 7 1 134.0 1 159.0 e 1 140.5 1 16'3 0 9 1 1,475 / /71 0 l0 1 154. 1 176.5 . 176.0 /70.0 IZ 180.5 /75.0 13 1660 181.5 14 190 0 167 5 l5 44S 58.0